Grievance Grievant EID PL Hours SDO ID: 335626
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vance/Arbitration Checklis Grievance # _______________________ Grievant: ____________________ EID # ____________ P/L ____ Hours _______ - ______ SDOs _____/_____ Level ____ Step ____ Straight-time hourly salary: $_______ per hour (include copy of current Pay Chart) 1. Date/Time of the call-in to ERMs: _______________________________________________ 2. Date(s) the grievant was out from work & type of Leave: ________________________________ Cost to grievants Health Plan to obtain documentation (include copy of EOB) $_______