APPENDIX R COUNTY GRIEVANCE FORM

Montgomery County, Office of Labor Relations
Department/supervisor Grievance Response Form

You are required to complete this form because an employee you supervise has filed a grievance.

For more information about the County Grievance Procedure contact the Labor/Employee Relations Team on 240-777-5114, review Section 34 of the Montgomery County Personnel Regulations [COMCOR 33.07.01.34], or go to Section 34 at

https://www.montgomerycountymd.gov/HR/Resources/Files/Regulation/MCPR%202001%20Section%2034.pdf

SUPERVISOR’S RESPONSE:               Date Received ______________________

Supervisor’s Name and Signature ______________________________________   Date ______ ______ ___

RESOLVED: Yes___ No___ (If not resolved, employee has ten calendar days upon receipt of response to appeal to next step.)

DEPARTMENT/AGENCY HEAD’S RESPONSE:         Date Received ______________________

Department Agency Head’s Name and Signature __________________________   Date ______ ______ ___

Employee’s Signature ______________________________________________   Date ______ ______ ___

RESOLVED: Yes___ No___ (If not resolved, employee has ten calendar days upon receipt of response to appeal to next step.)

OHR DIRECTOR’S RESPONSE:               Date Received __________________ ____

OHR Director’s Signature ___________________________________________   Date ______ ______ ___

Employee’s Signature ____________________________________________________   Date ______ ______ ___

RESOLVED: Yes___ No___ (If not resolved, employee has ten calendar days upon receipt of response to appeal to next step.)

CHIEF ADMINISTRATIVE OFFICER’S RESPONSE:      Date Received ______________________

Chief Administrative Officer’s Signature ______________________________________   Date ______ ______ ___

RESOLVED: Yes___ No___

A grievance may be appealed to the Merit System Protection Board within 10 working days of receipt of the Chief Administrative Officer’s response.