Acts Online
GT Shield

Public Service Commission Act, 1997 (Act No. 46 of 1997)

Rules

Rules for Dealing with the Grievances of Employees in the Public Service

Annexure A : Grievance Form

 

Annexure A

 

GRIEVANCE FORM

 

PLEASE READ THE FOLLOWING INSTRUCTIONS BEFORE COMPLETING THE FORM

 

1. This form must be used to lodge a grievance (excluding an alleged unfair dismissal) when you are dissatisfied with an official act or omission and you have been unable to resolve the problem by using informal discussion.

 

2. You have to lodge your grievance within 90 days from the date on which you became aware of the official act or omission which adversely affects you.

 

3. You may be assisted or represented by a fellow employee or a representative or official from a recognised trade union.

 

4. It is important to complete all information accurately. When the form is completed, it must be given to the employee designated to facilitate grievances at your institution. The department will attach this form to the grievance documentation and it will be used through all stages of the grievance procedure.

 

5. At each stage where a person within the relevant structure of authority attempts to resolve the grievance, each party will complete the appropriate part of the form. You will be given an opportunity to respond to each and every comment.

 

6. At the conclusion of each stage of the grievance procedure, the department will provide you with a copy of the completed form.

 

7. Once the grievance has been resolved, you do not need to complete the rest of the form. The Human Resources Section of your department will then file the form. It will then be used to report statistics to the Public Service Commission annually.

 

8. You are required to complete Parts A and B of this form and to hand it to the designated employee who facilitates grievances at your institution. The employee will affix his/her signature in the block below part B of the form to indicate that the grievance has been received. Ensure that you receive a copy of the form where receipt of your grievance has been acknowledged.

 

9. Part C of the grievance form will be completed by the employer and yourself during the various stages where attempts will be made to resolve the grievance.

 

PART A: PERSONAL INFORMATION

To be completed by aggrieved employee:

Initials and surname

:

                                                                                                                       

PERSAL number

:

                                                                                                                       

Employing department

:

                                                                                                                       

Directorate

:

                                                                                                                       

Rank/Designation

:

                                                                                                                       

Date on which you became aware of the official act or omission

:

                                                                                                                       

Contact numbers

:

Tel No:                                  

Fax No:                                  

Name of representative (where applicable)

:

                                                                                                                       

Contact numbers of representative

:

Tel No:                                  

Fax No:                                  

Name of trade union (where applicable)

:

                                                                                                                       

Contact numbers of trade union

:

Tel No:                                  

Fax No:                                  

PART B: DETAILS OF GRIEVANCE

To be completed by aggrieved employee:

What are you aggrieved about? (If space below is not enough, please attach additional page(s)):

                                                                                                                                                                                                   

                                                                                                                                                                                                   

                                                                                                                                                                                                   

                                                                                                                                                                                                   

                                                                                                                                                                                                   

                                                                                                                                                                                                   

                                                                                                                                                                                                   

                                                                                                                                                                                                   

                                                                                                                                                                                                   

 

What solution do you propose?

                                                                                                                                                                                                   

                                                                                                                                                                                                   

                                                                                                                                                                                                   

                                                                                                                                                                                                   

                                                                                                                                                                                                   

 

SIGNED:

                                                                                                                               

EMPLOYEE                                                                   DATE

 

Receipt of grievance form acknowledged and copy given to aggrieved employee


DESIGNATED EMPLOYEE

DATE  

Name:

Bank:

PART C: GRIEVANCE RESOLUTION: LEVELS

NOTES:
• This part of the form makes provision for various levels of authority to attempt to resolve the dispute. There are, however, no prescribed levels for the  resolution of a grievance. Depending on the circumstances, one or more pages below need to be completed.

 

• If the grievance cannot be resolved up to the level of head of department, it has to be submitted to the executing authority (i.e. the page below that specifically refers to the executing authority has to be completed.

 

• The grievance must be dealt with by all the applicable levels (including the executing authority) within a period of 30 days, unless extended by agreement with the aggrieved employee.