FE5

Trade Union details

Name .................................................................................

Registered Address .................................................................................

Phone number/Mobile Number .................................................................................

E-mail Address .................................................................................

Worker(s) details

Name of worker represented .................................................................................

Occupation of Worker .................................................................................

Is the worker a member of the trade union mentioned above (Yes/No) .................................................................................

Has this issue been reported by the worker as a grievance (Yes/No) .................................................................................

Employer details

Name of employer .................................................................................

Contact person (preferably someone who has been involved in the internal settlement of dispute or grievance procedure)

.................................................................................

Type of business .................................................................................

Address: .................................................................................

Phone number/Mobile: .................................................................................

E-mail Address .................................................................................

Fax Number .................................................................................

Details of dispute (the problem)

Please explain what the dispute is about or list the matters in dispute:

.................................................................................

.................................................................................

.................................................................................

Note: If the dispute relates to a dismissal, please attach a copy of the employer’s statement that sets out the reasons for the dismissal. An employer is required to provide this statement under section 114 of the Act.

I declare that all internal procedures for settling disputes, as applicable, have been exhausted in accordance with section 168 and Schedule 6 of the Employment Relations Act 2007.

I now wish to report this matter to the Permanent Secretary.

________________

Name of Trade Union/Name of Employer (delete whichever applicable)

________________

Signature of the Trade Union’s General Secretary/ Signature of Employer (delete whichever applicable)

.................

Date

Note

• •A report of a dispute is only entertained by the Permanent Secretary if it is within 6 months from the date on which the dispute arose “except where the delay to report was caused by mistake or other good cause” (sections 170(6) and 170(9) of the Act).
• •The party reporting the dispute must, within 3 days, provide a copy of this Form and any attachment(s) to each party to the dispute.
• •Additional attachment(s) to this Form can also be forwarded if the reporting party believes that the information is necessary to facilitate the decision of the Permanent Secretary eg copy of relevant collective agreement.

Case Number:................................................................(to be filled by the Ministry)