Kaiser Permanente

Second Step Grievance Request Form

Date:	Click here to enter a date.

To:	Click here to enter text.

From:	Click here to enter text.

The Union is requesting a Second Step Grievance meeting on behalf of employee:

Name: Click here to enter text.

Facility/Center: Click here to enter text.

Department: Click here to enter text.

Job Classification: Click here to enter text.

First Step Grievance was filed: Click here to enter a date.

☐ The meeting was held: Click here to enter a date.

- or -

☐ The meeting was not held. OPEIU Local 2 is requesting to move to the Second Step.

Please contact Sarah Levesque at slevesque@opeiu-local2.org or (240) 381-5045 to schedule the Second Step meeting date, time and location.

cc:	Sarah Levesque, Staff Representative, OPEIU Local 2*

Name of grievant

Name of Head Steward

☐ Attachment(s):

1. Title of document

2. Title of document

3. Title of document

4. Title of document

*All First Step hearing notes must be attached to the copy given to Sarah Levesque only.