IBEW LOCAL UNION 1613
STATEMENT OF GRIEVANCE - STEP NO. 1

Employee or Group Involved_____________________________________  Dept.__________________

Contract Reference:  Art.__________,  Sect.___________, Pg._______,  Other____________________

Date action complained of occurred or became known___________________

Date discussed with Supervisor_____________     Supervisor's Name____________________________

Date Supervisor answered__________________

NATURE OF GRIEVANCE

REPLY TO GRIEVANCE

RECOMMENDATION OF STEWARD

      Steward's Signature __________________________

                                                                                        Date  __________________________


Steward:  Make a copy of this grievance for your future use.