FORMAL GRIEVANCE
THIS FORM MUST BE COMPLETELY FILLED OUT
Name of Grievant:
Job Title:
Reports to:
Dept.
Date of Filing:
Date, time and place of event leading to
grievance:
Contact #:
Send documents to external representative
Date you became aware of the event, (if
different):
Detailed description of grievance including names of other persons involved, if any :
Proposed solution to grievance:
Grievant: File a copy of this form with your immediate supervisor and retain a copy
for filing at the next step or steps (see instructions on page 2 for a description of who
to file with for steps 1 through 4) if necessary. If you do not receive a response within
10 working days or disagree with the action taken, you may file a copy of the
grievance at the next step.
Grievance Filed With
Step
Date
Grievant's Signature
Date
(Please Print Name)
1
2
3
4
See instructions on page 2 of this form for procedures to be followed in filing a formal grievance.
Noble Multispeciality Hospital
NMH/ HR
Confidential For internal consumption only
GRIEVANCE PROCEDURE
A grievance is defined as an act, omission or occurrence which a permanent employee feels
constitutes an injustice and can be established on factual information. It may relate to any
condition arising out of the relationship between an employer and an employee, including
but not limited to, compensation, working hours, working conditions or the interpretation of
any law, regulation or disagreement. It does not include position allocation, involuntary
transfers, dismissals, demotions, or suspensions. The grievance procedure and statements
made on this form do not include all the rights available to a grievant.
Instructions for All Parties (Employee and Management)
1. All parties may consult with and receive the assistance of their department personnel offices or the
Division of Human Resource Management in resolving a grievance . Division of Human Resource
Management contact information can be obtained by calling 7110711 or writing to
andretyagi@noblebhopal.com.
2. A formal grievance must be filed within 20 working days following origin of the grievance or the date an
employee who feels aggrieved learns of the problem. Every effort should be made to resolve the
grievance by informal discussion during this 20-day period
3. Except for grievances filed with the EMC, the time limit for filing a grievance and for taking any action
required by either party at steps 1-3 in the grievance procedure may be extended by the mutual
agreement of the parties.
Instructions for The Employee Submitting A Grievance (Grievant)
1. When a formal grievance is filed, all the information requested on the form must be provided. The
description of the grievance should include the names of other persons involved in the act, omission or
occurrence.
2. The normal course of action in the grievance procedure is as follows:
Step
Step
Step
Step
1:
2:
3:
4:
File with Immediate Supervisor - If not resolved within 10 working days, take next step.
File with Division Head - If not resolved within 10 working days, take next step.
File with Department Head - If not resolved within 10 working days, take next step.
File with Employee-Management Committee - Within 45 working days of receipt of the
request, the EMC will render a decision or schedule a hearing and then render a decision.
Resolution conference: After a grievance has been submitted at Step 4, either the grievant or the
agency may choose to request a resolution conference. A resolution conference is an informal
meeting between the parties with the assistance of a neutral facilitator, provided by the Division of
Human Resource Management, who is not affiliated with either of the parties. The resolution
conference option provides an additional opportunity for a grievance issue to be discussed and for
possible solutions to be considered. If the Employee-Management Committee has notified the
parties of consideration of the date on which it will hold a hearing to consider the grievance, the
request for a resolution conference may not be submitted less than 15 working days before that
date.
3. Following receipt of notification of action at steps 1-3, the grievant has 10 working days to refer the
grievance to the next step unless the time limit is extended by agreement of the parties. A grievance
may be submitted to the next level if the grievant has not received notification within the 10 working
day period in which such action is required. The respondent, at each step, retains the documentation
received from the grievant. The grievant is responsible for maintaining copies of the documentation he
or she provided for his or her records and for filing at the next step in the grievance procedure,
including attaching all previous responses when submitting the grievance to the next step.
Noble Multispeciality Hospital
NMH/ HR
Confidential For internal consumption only
