Grievance Form (PPSM)

The PPSM Grievance Form is a Microsoft Word document that can be completed on line, saved, attached to an e-mail, and sent to Human Resources. Alternatively, it can be completed on line, printed out, and sent to Human Resources by e-mail. If you submit the form electronically, you must submit a hard copy showing the original signature within 5 calendar days of the original filing deadline. The complaint will not be processed until a copy with the original signature is received by the Grievance Coordinator. See below for details. You may wish to save it wherever you normally save documents on your computer (e.g., Worddocs).

To complete the form:

• Move your cursor to the grey space in any field. The grey space supports an unlimited amount of text, although it looks small. Keep typing and it will expand. (However, please be succinct.) Do not use the Enter key to add space.
• Use the tab buttons to move from line to line.
• When you have a choice of boxes, enter an X in the box that reflects the correct choice by clicking inside the box. Please check only one box where appropriate.

Open Grievance form  (Word)

Process tips:
Any formal complaint regarding a specific adverse management act or allegation of a violation of Personnel Policies for Staff Members must be filed on this form and submitted to Human Resources, 2199 Addison St., Room 192 (University Hall), Berkeley, CA 94720-3540, within 30 calendar days of the incident you are grieving. See Policy 70 and the procedures that supplement Policy 70 for details on filing grievances.

Instructions for completing and filing the form are contained in the Berkeley Campus Implementing Procedures that supplement Policy 70.

Note: this grievance form does not pertain to classification appeals (see Policy 70.A.)