Ps Form 8190 - Usps-Nalc Joint Step A Grievance Form
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1
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3Date Received at Step B
(MM/DD/YYYY)
USPS-NALC Joint Step A Grievance Form
INFORMAL STEP A — NALC Shop Steward Completes This Section
(See instructions on page 2.)
1. Grievant’s Name (Last, first, middle initial)
2. Grievant’s Telephone No. (Include area code)
3. Seniority Date
4
Status (Check one)
5. Grievant’s Employee Identification Number (EIN)
(MM/DD/YYYY)
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CCA
FT
FTF
PTR
PTF
6. District, Installation, Work Unit, ZIP Code®
7. Finance No.
8. NALC Branch No.
9. NALC Grievance No.
10. Incident Date
11. Date Discussed With Supervisor (Filing date)
(MM/DD/YYYY)
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12a Companion MSPB Appeal?
Yes
No
12b. Companion EEO Appeal?
Yes
No
13a. Supervisor’s Printed Name, Initials, and Telephone No.
13b. Steward’s Printed Name, Initials, and Telephone No.
FORMAL STEP A — Formal Step A Parties Complete This Section
(See instructions on page 2.)
14. USPS Grievance No.: Obtain prior to Formal Step A meeting.
15. Issue Statement: Provide contract provision(s) and frame the issue(s).
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16. Undisputed Facts: List and attach all supporting documents. Use additional paper if necessary.
Attachments?
No
Yes Number ____
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17. UNION’S full, detailed statement of disputed facts and contentions: List and attach all
Attachments?
No
Yes Number ____
supporting documents. Use additional paper if necessary.
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18. MANAGEMENT’S full, detailed statement of disputed facts and contentions: List and attach all
Attachments?
No
Yes Number ____
supporting documents. Use additional paper if necessary.
19a. Union Representative: Enter the remedy requested by the union.
19b. Settlement Offer: List any settlement offers by either party on page 3.
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20. Disposition (Check one)
Resolved
Withdrawn
Not Resolved
Date of Formal Step A Meeting
)
(MM/DD/YYYY
21a. USPS Representative’s Name
21b. Telephone No. (Include area code)
21c. USPS Representative’s Signature
21d. Date
(MM/DD/YYYY)
22a. NALC Representative’s Name
22b. Telephone No. (Include area code)
22c. NALC Representative’s Signature
22d. Date
(MM/DD/YYYY)
8190,
March 2016 (Page 1 of 3) PSN 7510-05-000-4168
PS Form
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