“ANNEX A”

GRIEVANCE FORM

_______________________
Date Filed

__________________________________ __________________________________
Name of Complainant/Aggrieved Party Section/Division/Office

__________________________________ _____________________________________
Position Title/Designation (if any) Complainant/Aggrieved Party’s
Higher Supervisor

Nature/Subject of Complaint/Grievance

Action Desired:

__________________________________________
 Signature of Complainant/Aggrieved Party
“ANNEX B”
GRIEVANCE AGREEMENT FORM

_______________________
Date

Name of Parties to a Complaint/Grievance :_______________________________________

:_______________________________________

Name/Subject of Complainant/Grievance :________________________________________

Steps Toward Settlement :_______________________________________

Agreement/s Reached:

We promise to abide by the above-stated agreement:

_______________________________ _________________________________
Complainant/Aggrieved Party Subject of Complaint/Grievance

__________________________________
Chairman of Grievance Committee
“ANNEX C”

CERTIFICATE OF FINAL ACTION ON THE GRIEVANCE

This certifies that the complainant/grievance filed by ______________________

on _________________ has been acted upon by this Committee on __________________.

Final Action Taken:

_______________________________ _________________________________
Date Chairperson
Grievance Committee

__________________________________
Chairman of Grievance Committee