Common use of Action Taken Clause in Contracts

Action Taken. □ This action/information satisfies my request/concern. □ This action/information does not satisfy my request/concern and I will be submitting this issue to the formal grievance process. Employee Name and Signature Date Employee’s Name: Address: APT# City: State: Zip: Phone/Home: Work: Pager: Cell: Employer/Dept/Div: Work Location: Shift/Work Days: Job Title: Date of Hire : Rate of Pay : yr/hr : Immediate Supervisor’s Name: ▇▇▇▇▇▇▇’▇ Name: Date of Incident: Was this issue discussed with your supervisor (date):

Action Taken. □ This action/information satisfies my request/concern. □ This action/information does not satisfy my request/concern and I will be submitting this issue to the formal grievance process. Employee Name and Signature Date Employee’s Name: Address: APT# City: State: Zip: Phone/Home: Work: Pager: Cell: Employer/Dept/Div: Work Location: Shift/Work Days: Job Title: Date of Hire : Rate of Pay : _yr/hr : Immediate Supervisor’s Name: ▇▇▇▇▇▇▇’▇ Name: Date of Incident: Was this issue discussed with your supervisor (date):