Employee Grievance Check List

Dear All,
Its Amit Kumar, HR Professional, working with a reputed construction company. I am in dire need of Grievance check list format.. Can anyone help me regarding the same.
An early reply would be highly appriciated.
With Best Regards,
Amit Kumar

Dear Amit:
The following is submitted in response to your request for a grievance checklist.
Grievance Checklist
Employee Name:
Employee No.
Department:
Supervisor:
Describe Incident Fully and completely: (Who, What, Where, When, Why, How)
All Witnesses: (name and title)
Contract/Work Rule Allegedly Violated:
Past Practice: (Yes/ No)
If yes, describe: (Who, What When, Where, Witnesses)
Degree of Misconduct: (Serious/ Non-serious)
Statements of Aggrieved Employee, Supervisor, and Witnesses
Record of Aggrieved Employee (Include length of service/ negative performance reports/ positive performance reports/ supervisor’s evaluation/ etc.)
Hope this helps.
PALADIN