PASRS Grievance Form

Grievance Form

Use this form to report a grievance against a PASRS Member. Completion of this form will begin an investigatory process per the PASRS Grievance Policy.

Date Complaint Completed*
Name of Reporting Person*
First Last
Reporting Company Name*
Reporting Party's Title at Company*
Reporting Party's Email
Reporting Party's Phone- Work*
Reporting Party's Phone- Cell
Name of Person Reported in Grievance (if applicable)
First Last
Company Reported in Grievance*
Reported Company/Person's Email
Reported Company's Phone- Work
Date Grievance Occurred*
Reason for Grievance/s*
Details of Grievance/s*
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