Appendix 1

To raise a formal grievance, please complete this form and send it, in an envelope marked confidential, to your Headteacher (or the Chair of the Governing Body where appropriate)

Name: (please print) Date:

School: ……………………………………………….

I wish to register a grievance against: ……………………………………………………

(name of manager)

My Grievance is (brief summary):

Details of Grievance (Please set out the incident(s) leading to the grievance with dates and any other relevant information. Use additional pages if necessary). (Note: grievances must be registered as soon as possible after the decision which has caused you to be aggrieved. If this was more than three months ago, please explain why your grievance could not be registered earlier).

I have discussed this grievance with: ………………………………………………………

The outcome of this discussion was:

I remain aggrieved because:

I wish to exercise my right to raise my grievance with you. The redress I am seeking is:

My representative is: ………………………………………………………………

Address:

Telephone: ………………………………………………………………….………

My contact address:

Telephone: …………………………………………………………………………