forms

American Postal Workers Union, AFL-CIO

Step 2 Grievance Appeal Form

Please ensure all fields are filled out completely and accurately.

Email:

admin@phillyapwu.com

Phone:

(610) 522-4520

Location:

864 Main Street, Darby PA 19023

1. General Information

Discipline (Nature Of) or Contract (Issue)

Craft

Date

Local Grievance #

USPS Grievance #

2, 3, 4 & 5. USPS & Union Representative Details

To USPS Step 2 Designee (Name and Title)

PLANT MANAGER, P & DC
DISTRICT MANAGER, CUSTOMER SERVICE
PLANT MANAGER, AMC

Installation / Sec. Cen. / BMC & Phone

PHILADELPHIA, PA POSTAL SERVICE
(215) 749-4308 | (215) 863-6063 | (215) 937-5600

From: Local Union (Name & Address)

Step 2 Authorized Union Rep (Name/Title) & Phone

Local Union President & Phone

6 & 7. Step 1 Meeting & Decision

Unit / Sec / Br / Sta / Ofc

Date/Time Met

USPS Rep - Supr

Grievant and/or Steward

Step 1 Decision By (Name and Title)

Date and Time of Decision

Initials

8 & 8A. Grievant Information

Grievant Person or Union (Last Name First)

Address

City

State

Zip

Grievant E-Mail Address

Phone

9 & 10. Job & Status Information

EIN #

Seniority

Craft

Status

Level

Step

Duty Hours

Off Days (Check all that apply)

SA SU M T W TH F

Job # / Pay Location / Unit / Sec / Br / Sta / Ofc

Work Location City and Zip Code

Lifetime Security

Veteran

11 & 12. Violations & Statement of Facts

Pursuant to Article 15 of the National Agreement we hereby appeal to Step 2 the following Grievance alleging a Violation of (but not limited to) the following:

NATIONAL (Art. / Sec.), LOCAL MEMO (ART. / SEC.), OTHER MANUALS, POLICIES, L/M MINUTES, ETC.

DETAILED STATEMENT OF FACTS / CONTENTIONS OF THE GRIEVANT

American Postal Workers Union, AFL-CIO (Local 89)

Request for a Union Steward

Please fill out the request details below. Management will complete the bottom section.

Email:

admin@phillyapwu.com

Phone:

(610) 522-4520

Location:

864 Main Street, Darby PA 19023

1. Request Details

Date

To: (Name)

To: (Title)

From: (Name)

From: (Title)

Time Requested (At ___ AM/PM)

Hours Requested (I am requesting at least...)

Grievances (Hours requested to work on the following:)

2. Management Representative (For Office Use Only)

Request Status

Reason for Denial (If applicable)

When will the Union Steward time be given?

Print Supervisor / Manager Name

Signature

Date / Time (Signed)

American Postal Workers Union, AFL-CIO (Local 89)

DON'T LET MANAGEMENT STEAL YOUR JOB!!!

If a supervisor/manager is doing bargaining unit work, that supervisor/manager is stealing your job. The only way the Union can stop this is to be made aware of it.

Email:

admin@phillyapwu.com

Phone:

(610) 522-4520

Location:

864 Main Street, Darby PA 19023

1. Fill Out This Form (Incident Details)

I have witnessed Supervisor/Manager (Name)

Violate Article 1 of the National Agreement on (Date)

The bargaining unit work was performed from (Time AM/PM)

To (Time AM/PM)

For a total of (Hours)

And (Minutes)

Describe the bargaining unit work performed in detail:

2. Reporter Details

Station:

Print Name:

Signature:

FULL EIN:

Please give this form to your APWU Steward, Chief Steward or FAX to the Union Office at (610) 522-4533.

American Postal Workers Union, AFL-CIO (Local 89)

Take Your Breaks and Lunches On Time

Fill Out This Form

Email:

admin@phillyapwu.com

Phone:

(610) 522-4520

Location:

864 Main Street, Darby PA 19023

Management has violated Article 37.12 of the LMOU when they failed to allow me to take my break and/or lunch within the time limits agreed to.

Section 12. Anti-Fatigue Break A. All clerks will be given a 15-minute anti-fatigue break before lunch and after lunch. An additional 15-minute break will be given for a call of two (2) hours overtime B. After approximately two (2) hours, employees will be given a 15-minute anti-fatigue break. Scheduled breaks shall not immediately precede a lunch period or an employee tour change, shall not exceed two (2) in one tour, except when overtime is worked and shall not interfere with dispatch schedules.

1. Violation Timeline

Date of Violation:

Begin Time (BT):

First Break:

Out to Lunch:

In From Lunch:

Second Break:

End Time:

2. Employee Information

Print Name:

EIN:

Station:

Phone Number:

Signature:

Please give this form to your APWU Steward or FAX to Union Hall at (610) 522-4533.

American Postal Workers Union, AFL-CIO (Local 89)

Working Alone at Postal Facility

Fill Out This Form

Email:

admin@phillyapwu.com

Phone:

(610) 522-4520

Location:

864 Main Street, Darby PA 19023

This FORM is to be used to report the times you had to work at a Postal Facility ALONE, in violation of Step 3 Settlement, whereas there will be at least two (2) CLERKS schedules at all times. The only way the Union can stop this is to be made aware of it.

1. Incident Details

I (NAME) was the only CLERK in

The building at (STATION NAME)

On (DATE)

From (TIME AM/PM)

To (TIME AM/PM)

For a total of (HRS)

And (MIN)

Write Statement (below):

2. Reporter Details

Print Name:

FULL EIN:

Signature:

Please give this form to your APWU Steward, Chief Steward or FAX to the Union Office at (610) 522-4533.

American Postal Workers Union, AFL-CIO (Local 89)

Time Limit Extension

Fill Out This Form

Email:

admin@phillyapwu.com

Phone:

(610) 522-4520

Location:

864 Main Street, Darby PA 19023

Both parties mutually agree to extend the time limits for the following issues until:

1. Issues to Extend

1)

2)

3)

4)

5)

2. Management Representative

Management Representative Title:

Print Name:

Signature:

Date:

3. Union Representative

Union Representative Title:

Print Name:

Signature:

American Postal Workers Union, AFL-CIO (Local 89)

Request for Information & Documents

Email:

admin@phillyapwu.com

Phone:

(610) 522-4520

Location:

864 Main Street, Darby PA 19023

1. Request Received By

Signature:

Date:

Time:

2. Grievance Details

Grievant/Union:

Nature of Allegation:

Date of Request:

3. Memorandum

TO:

TITLE:

FROM:

TITLE:

SUBJECT: Request for Information & Documents Relative to Processing A Grievance

We request that the following documents and/or witnesses be made available to use in order to properly identify whether or not a grievance exists, and if so, their relevancy to the grievance.

1.

2.

3.

4.

5.

6.

Note: Article 17, Section 3, requires the Employer to provide for review all documents, files, and other records necessary in processing a grievance. Article 31, Section 3, requires that the Employer make available for inspection by the Unions all relevant information necessary for collective bargaining or the enforcement, administration or interpretation of this Agreement. Under 8a(5) of the National Labor Relations Act, it is an Unfair Labor Practice for the Employer to fail to supply relevant information for the purpose of collective bargaining. Grievance processing is an extension of the collective bargaining process.

4. Decision (Management Use)

Request Status:

Date:

Signature:

American Postal Workers Union, AFL-CIO (Local 89)

Step 2 Grievance Hearing Report

Email:

admin@phillyapwu.com

Phone:

(610) 522-4520

Location:

864 Main Street, Darby PA 19023

1. Hearing Details

Date of Hearing:

Union Rep:

E & LR Rep:

Grievant:

APWU #:

USPS #:

Violation #:

2. Hearing Status

Check One:

3. Positions & Decision

Union Position:

1. CONTENTIONS CITED ON THE STEP 2 APPEAL FORM

2. Additional Contentions (Page 1 & 2):

Management Position:

Decision:

Pre-Disciplinary Interview Steward Notes

1. Interview Details

Craft Member being interviewed:

Supervisor conducting interview:

Additional people in attendance:

Date of interview:

Interview Start Time:

Interview End Time:

2. Questionnaire

1. Did the supervisor forewarn the craft member what discipline was being considered?

2. Did the supervisor forewarn the craft member as to the specific charge?

3. Did the supervisor give the craft member an opportunity to read any information that was being relied upon or read the information to the craft member?

4. Did the supervisor ask the craft member for their side of the story?

5. Did the supervisor take notes of what the craft member had to say?

6. Did the supervisor read from a prepared set of questions or comments?

7. Did anyone else ask questions of the craft member?

3. Sign-off

Shop Steward:

(Use reverse side for notes)

Step 1 Grievance Outline Worksheet

1. General Information

Discipline (Nature Of) or Contract (Issue) [Box 1]:

Craft:

Date:

Local Grievance #:

USPS Grievance #:

Unit/Sec/Br/Sta/Ofc [Box 6]:

Date & Time:

USPS Rep - Supr:

Steward *:

2. Step 1 Decision & Grievant

Step 1 Decision By (Name & Title) [Box 7]:

Date & Time:

Initials: *Verifies date only

Grievant Person or Union (Last, First) [Box 8]:

Phone:

Address:

City:

State:

3. Employee Details

Social Security No. [Box 9]:

Service:

Seniority:

Craft:

Status:

Level & Step:

Duty Hrs:

Off Days:

Job & Pay Location [Box 10]:

Work Location City & Zip Code:

Lifetime Security:

Veteran:

4. Appeal Outline

11. Pursuant to Article XV of the National Agreement we hereby appeal to Step 2 the following Grievance alleging a Violation of (but not limited to) the following:

NATIONAL (Art./Sec.):

LOCAL MEMO & OTHER:

(a) PROBLEM:

(b) BACKGROUND:

(c) DOCUMENTS:

(d) CORRECTIVE ACTION:

(e) MANAGEMENT'S RESPONSE:

5. Steward Address

* Steward's Address (Street & No.):

City, State:

Zip:

Phone:

Grievant Statement Form

1. Grievance & Personal Information

Grievance #:

Page:

Of:

Name:

EIN #:

Address:

City:

State:

Zip Code:

Phone Number:

Craft:

2. Employment Details

Pay Location:

Hours of Duty:

Level:

Step:

Lifetime Security:

Veteran:

Drop Days:

Seniority Date:

Craft Seniority Date:

Status:

Work Location (Post Office & Zip):

3. Statement

I hereby state, to the best of my knowledge, that all statements herewith included in my statement, are facts as I know them and what I believe are true.

CORRECTIVE ACTION I REQUEST:

4. Sign-off

Today's Date:

Date of Violation:

Signature:

Step One Settlement

1. Grievance Information

Grievant:

Local Grievance #:

EIN:

GATS Number:

Pay Location:

Issue:

Union:

Craft:

( ) P&DC ( ) Station:

2. Agreement

Management and Labor Mutually Agree to the following settlement:

3. Signatures

Management Rep:

Print Name:

Signature:

Date:

Union Rep:

Print Name:

Signature:

Date:

CC:
LABOR
STEP ONE SUPERVISOR
DIR
CRAFT DIRECTORS

UNITED STATES POSTAL SERVICE

Step Two Settlement

1. Grievance Information

Grievant:

Local Grievance #:

EIN:

GATS Number:

Pay Location:

Issue:

Union:

Craft:

( ) P&DC ( ) STATION:

2. Agreement

Management and Labor Mutually Agree to the following settlement:

3. Signatures

Management Rep:

Print Name:

Signature:

Date:

Union Rep:

Print Name:

Signature:

Date:

CC:
PLANT MANAGER
POSTMASTER
LABOR RELATIONS
STEP ONE SUPERVISOR
OPF

Gwen Ivey
President

Farrell Anderson
Vice President

Phaedra Mitchell
Treasurer

Atiyah I. Ivey
Director of Industrial Relations

American Postal Workers Union, AFL.-CIO

Philadelphia, PA Area Local 89

864 Main Street Darby, PA 19023 Phone (610) 522-4520 Fax (610) 522-4533

APWU

DATE:

United States Postal Service
Medical Unit
7500 Lindbergh Blvd #1047K
Philadelphia, Pa. 19176

To Whom It May Concern,

I authorize a designated Steward and/or Union Official of the Philadelphia, PA Area Local #89, American Postal Workers Union, AFL-CIO to have access to my personnel folder in the work section and/or in the personnel section. This includes all medical records, documents, files and other records that are maintained by the United States Postal Service. I also authorize my Union Representative to obtain copies of all documents, files and other records including medical records, that the Union deems necessary to properly represent me in the Grievance-Arbitration procedure.

EMPLOYEES NAME (PRINT):

SIGNATURE:

EIN:

WORK LOCATION:

TOUR:

PAY LOCATION:

Grievant Statement Form

1. Grievance & Personal Information

Grievance #:

Page:

Of:

Name:

EIN #:

Address:

City:

State:

Zip Code:

Phone Number:

Craft:

2. Employment Details

Pay Location:

Hours of Duty:

Level:

Step:

Lifetime Security:

Veteran:

Drop Days:

Seniority Date:

Craft Seniority Date:

Status:

Work Location (Post Office & Zip):

3. Statement

I hereby state, to the best of my knowledge, that all statements herewith included in my statement, are facts as I know them and what I believe are true.

4. Sign-off

Today's Date:

Date of Violation:

Signature: