Complaint Form Submission

Personal Information
Todays Date*
MM slash DD slash YYYY
Incident Date:*
MM slash DD slash YYYY
Name*
First Last
Job Title*
Grade (GS)
Work Phone
Agency/Center/Office*
Duty Hours
Work Email*
Personal Email
Complaint / Incident Information
Suspected Violations*
- Provisions of the Collective Bargaining Agreement
- Provisions of your office's local agreements
- Personal bias
- Union Activity
- Alleged poor performance
- Alleged poor conduct
- Discrimination
Please check the box(es) that you feel your complaint or incident violates.
Complaint*
Please provide a description of the act or incident. Please include the following: 1) A description of the act or incident, including date and location; 2) Why it happened: personal bias, union activity, alleged poor performance or conduct, discrimination; 3) Name, job title, grade, work unit, organization, email and duty phone of each witness who knows the facts about the complaint.
Remedy Sought*
In one sentence, what action do you think Management should take to resolve your complaint?
Actions Already Taken
Have you talked with your direct supervisor about it?*
- Yes
- No
If yes, Please briefly describe the encounter.
Name of your direct supervisor.
First Last
Supervisor's Work Phone
Have you consulted with any other Management official(s) about it?*
- Yes
- No
If yes, Please briefly describe the encounter.
Have you submitted your compaint to Management in writing and/or email?*
- Yes
- No
If yes, please be prepared to submit, to your union steward(s), a copy of your complaint to Management and any related correspondence/documents upon request.
Do you have any additional documents you wish to provide?
Max. file size: 64 MB.
Please do not submit any PII or sensitive information. Such documents should be sent directly to a National Officer once they reach out to you.
Consent
Consent to Representation / Acknowledgement of Terms*
By agreeing below, you hereby designate NFFE Local 1998 to represent me in the above-described complaint. I understand that NFFE Local 1998 is not obligated to take my complaint to arbitration.
I Agree
Additional Comments
Items like personal preferences to how we communicate with you, privacy concerns, etc.

Personal Information

Complaint / Incident Information

Actions Already Taken

Consent