Please fill out all required fields.
Employer / Company Name *
Your Name & Surname *
Your e-mail address *
Your Contact Number *
Employee Name & Surname *
What Town is the Employee stationed *
Please Provide a Full Description of the Event *
Date of the Offence *
Time of the Offence
What does the incident relate to? *
- please choose - Absence Without Permission Actions Detrimental to the Employment Relationship Assualt Bringing the Employer into disrepute Conflict of Interest Damage to company property Dereliction of duty Dishonesty Foul language Harrasment Health and Safety Insolence Insubordination Negligence Not following policies & Procedures Poor timekeeping Possession of dangerous weapon at the workplace Reckless and negligent driving Threats of assault Sexual Harrasment Unauthorized possession of company property Under the Influence of intoxicating substance Other
Is the Employee a Shop Steward *
- please choose - No Yes
When should the hearing take place? *
Where should the hearing take place? *
What time would you prefer? *