Ontario Nurses' Association Local 8 - Windsor Regional Hospital

Grievance Fact Sheet

Demographics

Fields marked with a (*) are mandatory
Name (*):		Unit/Department (*):
Address (*):		Home Phone # (*):
Address (*):		Cell Phone #:
Status (*):		Date of Hire (estimate if not sure):
Personal Email:		Manager/Supervisor (*):

Event/Occurrence

Date of Occurrence (*):

Include all information i.e. what happened, who was involved, when did it happen, where did it happen, why you feel this is a grievance. (*)

Sending additional documents:

To submit additional documents, send to:
Caroline Cohen

Fax: 1-866-544-0733 - you MUST send a cover sheet or write your name on all sheets sent

Indicate what will be forwarded:

What do you want as a resolution? (*)

Attempts to Resolve

Complained to immediate Manager/Supervisor

Name of person contacted (*):

Date (*):

Response of manager/supervisor:

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