Ps Form 8190 - Usps-Nalc Joint Step A Grievance Form

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Date Received at Step B (MM/DD/YYYY)
USPS-NALC Joint Step A Grievance Form
INFORMAL STEP A — NALC Shop Steward Completes This Section
1. Grievant’s Name (Last, first, middle initial)
2. Home Telephone No.
4. Status (Check one)
5. Grievant’s SSN
3. Seniority Date (MM/DD/YYYY)
FT
FTF
PTR
PTF
TE
6. Installation/Work Unit
7. Finance Number
8. NALC Branch No.
9. NALC Grievance No.
10. Incident Date (MM/DD/YYYY)
11. Date Discussed with Supervisor (Filing Date)
43
12a. Companion MSPB Appeal?
12b. Companion EEO Appeal?
Yes
No
Yes
No
13a. Supervisor’s Printed Name and Initials (Completed by Supervisor)
13b. Steward’s Printed Name and Initials (Completed by Steward)
FORMAL STEP A — Formal Step A Parties Complete This Section
14. USPS Grievance No.
15. Issue Statement/Provide Contract Provision(s) and Frame the Issue(s)
16. Undisputed Facts (List and Attach All Supporting Documents)
Attachments?
No
Yes
Number______
17. UNION’S full, detailed statement of disputed facts and contentions (List and Attach
Attachments?
No
Yes
Number______
All Supporting Documents)
18. MANAGEMENT’S full, detailed statement of disputed facts and contentions (List and Attach
Attachments?
No
Yes
Number______
All Supporting Documents)
19. Remedy Requested/Offered
20. Disposition and Date (Check one)
Date of Formal Step A Meeting (MM/DD/YYYY)
Resolved
Withdrawn
Not Resolved
21a. USPS Representative Name
21b. Telephone No. (Include Area Code)
21c. USPS Representative Signature
21d. Date (MM/DD/YYYY)
22a. NALC Representative Name
22b. Telephone No. (Include Area Code)
22c. NALC Representative Signature
22d. Date (MM/DD/YYYY)
8190
PS Form
, August 2002 (Page 1 of 2)

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