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Doc NO:
LR 7
Revision:
1
Next Revision: Jan 2026
Controlled by:
Authorised by:
Subject: Grievance Form
Employee name: ______________________________________
Designation: __________________________________________
Employee Representative: ______________________________
Employee Supervisor: __________________________________
Stage 1: Formal Grievance
Date: ___/___/2026
Nature of Grievance:
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Reason for grievance not resolved informally:
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Statement of the grievance:
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Settlement reached / sought:
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Stage 2: Grievance Appeal
Date: ___/___/2026
Reason for grievance not being resolved during stage 1:
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Explanation of continued dissatisfaction:
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Signature Supervisor
Signature Supervisor
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Signature Employee
Signature Employee
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Signature Representative
Signature Representative
Notes of presiding officer
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Date
Date
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Signature
Signature