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HomeMy WebLinkAboutResolution 2011 (78) I RESOLUTION APPROVING EMPLOYEE GRIEVANCE SYSTEM ~ ( Q b I I 2 Resolution No. S 3 St. Croix County, Wisconsin 4 5 WHEREAS, Wisconsin Statutes § 66.0509 (1) requires local governmental units, which 6 includes counties, to establish a civil service system or grievance system that establishes 7 procedures for dealing with employee terminations, employee discipline, and workplace safety; 8 and 9 10 WHEREAS, if a local governmental unit creates a grievance procedure, the procedure 11 shall contain at least all of the following elements, pursuant to Wisconsin Statutes § 66.0509 12 (lm) (d): 13 14 1. A written document specifying the process that a grievant and an employer must 15 follow. 16 2. A hearing before an impartial hearing officer. 17 3. An appeal process in which the highest level of appeal is the governing body of the 18 local governmental unit. 19 20 WHEREAS, the Administration Committee reviewed and recommends approval of the 21 attached Grievance and Appeal Policy as Article 9 of the Human Resources Policies and 22 Procedures Handbook. 23 24 THEREFORE, be it resolved by the St. Croix County Board of Supervisors that the 25 Grievance and Appeal Policy attached hereto is approved effective immediately as Article 9 of 26 the Human Resources Policies and Procedures Handbook. Offered b Administration Committee Yes No Abstain Absent This resolution was adopted by the St. Croix County Sharon Norton-Bauman ® ❑ ❑ ❑ Esther Wentz ® ❑ ❑ ❑ Board of Supervisors off:fi41ae:rti/0_e"_ 1 -20 / r Ryan Sicard ® ❑ ❑ ❑ Daryl Standafer ® ❑ ❑ ❑ Buck Malick ® ❑ ❑ ❑ Lorin Sather ® ❑ ❑ ❑ _ Roger Rebholz ® ❑ ❑ ❑ Cindy Campbe , 'County Jerk I v rify that the vote shown above i rue and correct. County Board Vote: Yes Gc' r wC D No Chair, Admini trati Committee o Abstain Absent LEGAL REVIEW FISCAL REVIEW Reviewed as to form on October 17, 2011 ® There is a fiscal impact. Greg 2-immerm.an ❑ There is no fiscal impact. Greg Timmerman, Corporation Counsel See attached Fiscal Impact Statement. LEGAL NOTE: None VOTE REQUIREMENT: Maori of supervisors resent FISCAL IMPACT STATEMENT Submitted By: Tammy Funk Date: 10/12/2011 Department: Human Resources Committee: Administration Resolution Title: RESOLUTION AMENDING HUMAN RESOURCES POLICIES AND PROCEDURES HANDBOOK RELATING TO EMPLOYEE GRIEVANCE AND APPEAL POLICY ❑ There is no fiscal impact on expenses or revenues ® There is a fiscal impact on expenses or revenues Explanation: There is a minimal fiscal implact to this resolution as the county will be responsible for costs associated with the requirement for an Impartial Hearing Officer. FINANCE DIRECTOR ACTION: Approved by Finance Director Signature: Date: FISCAL IMPACT STATEMENT -REV. 09/12/2011 Page 1 ARTICLE 9 --Grievance and Appeal Policy Purpose This grievance policy provides an employee with the individual opportunity to address concerns regarding discipline, termination or workplace safety matters, to have those matters reviewed by an impartial hearing officer and to appeal to the County Board, where appropriate, as required by Wis. Stat. § 66.0509. The county expects employees and management to exercise reasonable efforts to resolve any questions, problems, or misunderstandings prior to utilizing the grievance procedure. If an employee is subject to a contractual grievance procedure, the contractual grievance procedure must be followed as applicable. This policy does not replace or supersede any statutory provision which may be applicable to an employee's employment with the County. This grievance policy supersedes any other grievance procedure in place for non-represented employees. This policy is not a guarantee of employment, a guarantee of any rights or benefits, does not create or grant employees with a property interest in their employment or tenure rights of any kind and does not constitute a contract of employment, express or implied. Definitions t . "Employee" for purposes of the procedure for grievances concerning employee discipline and employee terminations includes regular full-time and part-time employees who have completed twelve (12) months of continuous employment with the County, beginning with their most recent date of hire. The term "employee" excludes elected officials; temporary employees (including limited term, casual, or seasonal); project employees, independent contractors or their respective employees; unpaid interns, volunteers, employees within their first twelve (12) months of employment, beginning with their most recent date of hire; employees covered by a collective bargaining agreement that addresses discipline and termination; and any employee, official or officer that serves at the pleasure of an appointing authority as provided by Wisconsin Statutes. For purposes of this policy, the Employee may only initiate and file a Grievance for the Employee's own discipline or termination. 2. "Employee" for purposes of the procedure for grievances concerning workplace safety, includes regular full-time and part-time employees, elected officials; temporary employees (including limited term, casual, or seasonal), and project employees, The term "employee" excludes independent contractors or their respective employees, volunteers, unpaid interns, and any person working for another employer whose office is located within County Facilities. For purposes of this policy, the Employee initiates and files a Grievance for workplace safety. 3. "Discipline" is defined as an adverse employment action initiated by the County, and includes the following: unpaid disciplinary suspension of employment, disciplinary demotion or reduction in rank. "Discipline" does not include any of the following actions: terminations, resignations, layoffs, or workforce reduction activities, status changes, non-disciplinary wage, benefit, or salary adjustments or reductions; non- disciplinary reductions in rank or demotions; guidance and counseling, performance improvement plans; performance evaluations or reviews; verbal reprimands, written reprimands; paid and unpaid administrative leave pending an investigation, or change in assignment or assignment location. 4. "Termination" is defined as separation from employment initiated by the employer for disciplinary or performance reasons. "Termination" does not include layoff, furlough, or reduction in workforce, reduction in hours, job transfer, or reassignment, retirement, or death. 5. "Workplace Safety" is defined as conditions of employment related to the health and safety of employees in the workplace, including the safety of the physical work environment, the safe operation of workplace equipment and tools, provision of personal protective equipment, and accident risks. "Workplace Safety" does not include conditions of employment unrelated to workplace health and safety matters, including, but not limited to, hours, overtime, and work schedules. 6. "Grievance" is defined as a written complaint filed under this policy by an Employee involving discipline taken against the Employee, termination of the Employee, or an alleged workplace safety issue directly affecting the Employee. 7. "Employer" is defined as St. Croix County. General Provisions A. Forms A Grievance may only be filed by the Employee who is the subject of the Discipline or Termination. The Employee shall initiate a Grievance relating to Discipline or Termination by presenting a complete written Grievance on the Employee Discipline and Termination Grievance Form attached to this policy as Appendix 9-A. The Employee must sign and date the Form. A Grievance shall not be considered filed until the Employee signs the Form, provides all of the required information on the Form, and delivers a completed Form to the Department Head and a copy to the Human Resources Department. The Employee shall initiate a Grievance relating to Workplace Safety by presenting a complete written Grievance on the Employee Workplace Safety Grievance Form attached to this policy as Appendix 9-13. The Employee must sign and date the Form. A Grievance shall not be considered filed until the Employee signs the Form, provides all of the required information on the Form, and delivers a completed Form to the Risk Manager and a copy to the Human Resources Department. The Employee shall request a Hearing by an Impartial Hearing Officer for discipline, termination, or workplace safety by presenting a completed Request for Hearing Form attached to this policy as Appendix 9-C. The Employee must sign and date the Form. A request for a hearing shall not be considered filed until the Employee signs the Form, . provides all of the required information on the Form, and delivers a completed Form to the County Administrator. The Employee or Employer shall request an Appeal by the County Board for discipline, termination, or workplace safety by presenting a completed Request for Appeal Form attached to this policy as Appendix 9-D. The requesting parry must sign and date the Form. A request for an appeal shall not be considered filed until the Employee or Employer signs the Form, provides all of the required information on the Form, and delivers a completed Form to the County Administrator. By signing the Form, the Employee is declaring under penalty of law that the statement contained in a Grievance relating to Discipline, Termination, or Workplace Safety is true and correct to the best of the Employee's knowledge. Any Employee who files a Grievance that is false or misleading or for the purposes of intimidation, annoyance, or harassment or who otherwise files a Grievance in bad faith shall be subject to disciplinary action. B. Time Limits The term "days" as used in this Policy means working days, which is defined as Monday- Friday, and excludes Saturday, Sunday, and observed holidays. Days taken with available paid time or unpaid time shall be considered as working days for purposes of this Policy. A Grievance, a request for a hearing, or a request for appeal is considered timely if received by the specified department/division listed in the grievance procedure below between the hours of 8:00 a.m. and 4:30 p.m. or if faxed or postmarked by 12:00 midnight on the due date. Electronic (email) submissions shall not be recognized as a form of filing. The Employer and Employee may mutually agree, in writing, to waive any step to facilitate or expedite resolution of the Grievance. In the event the Grievance is not answered by the Employer within the time limits set forth in this Policy, the Employee may proceed to the next available step. The time limits set forth in this policy for purpose of the Employee's request for a hearing, or request for appeal in this Policy will start based on the postmarked date of correspondence sent to the Employee. The time limits set forth in this Policy for purposes of the Employers written determination and reply will start based on the stamp received date for the Employee's written Grievance or request for appeal. Any issues involving the timeliness of a Grievance shall be resolved by the County Administrator. C. Communication All correspondence from the Employer to the Employee will be delivered via U.S. Postal Service to the Employee's most recent mailing address on file in the Human Resources Department. D. Scheduling The Employee shall be allowed time away from their work duties to meet with the Employer to discuss the Grievance. Once the formal written Grievance has been filed, the Employee shall use his/her available paid time for said meetings, and must have prior approval from the Supervisor/Department Head for the time off. E. Representation The Employee shall have the right to representation during the Grievance Procedure at the Employee's expense. F. Costs Each party shall bear its own costs for witnesses and all other out of pocket expenses, including attorney fees, investigation, preparing, presenting, or defending a Grievance. The professional fee and any mileage, hotel, or meal accommodations for the Impartial Hearing Officer will be paid by the Employer. Costs associated with transcription of a digital recording of a hearing is described under Hearings. G. Role and Appointment of Impartial Hearing Officer The Impartial Hearing Officer shall be selected by the County Administrator based upon the nature of the matter in dispute. For the purposes of this policy, the role of the Impartial Hearing Officer will be to define the issues, identifying areas of agreement between the parties and identifying the issues in dispute, to hear the parties' respective arguments and to render a written decision. H. Hearing All hearings shall be closed to the public. It is the discretion of the Impartial Hearing Officer to determine if a digital recording of the hearing is to be made and if so, whether the digital recording of the hearing will be transcribed. The Hearing Officer will make that determination in a pre-hearing meeting or written order to the Employer. The determination for the Hearing Officer on the issue of transcription is final and non-appealable. In the event the Hearing officer determines that the digital recording of the hearing shall be transcribed, the Employer shall be responsible for the production and cost of the transcript and provide a copy of the transcript without charge to the other party. In the event the Hearing Officer determines that the hearing will not be transcribed, the Employee or Employer may have the digital recording of the hearing transcribed at its own expense, and shall provide a copy of the transcript without charge, to the other party. If the hearing is recording, the recording shall be destroyed upon the issuance of the written decision of the hearing officer. The Employer or the Employee may, at any time prior to the hearing, propose to settle the grievance. Any proposed settlement must be approved by the County Administrator on behalf of the Employer before it shall be considered final and binding on the Employer. Any final settlement shall be binding on both parties and not grievance or appealable. There shall be no pre-hearing discovery. The Employee and the Employer shall exchange a list of witnesses each party intends to call at the hearing and any documents and exhibits each party intends to introduce at the hearing no less than ten (10) days before the hearing. The Employee and the Employer shall each provide a copy of their respective witness list, documents and exhibits to the Impartial Hearing Officer. No witness, exhibit or document which was not identified or exchanged by a party may be introduced absent a written finding by the Impartial Hearing Officer that there was excusable neglect for the failure of the party to identify a witness or document within the deadline for exchanging witness lists or documents. Each party may file a pre-hearing statement of no more than two (2) typed written single space pages outlining its position relative to any issues related to the Grievance. The Impartial Hearing Officer may not serve as a mediator nor make any attempt to mediate the dispute. The Employee shall call witnesses and present testimony and exhibits that are relevant to the grievance first. The Employee may call one or more Employer witnesses in the Employee's case and question the Employer witnesses with leading questions. At the close of the Employee's case, the Employer shall call its witnesses and present testimony and exhibits that are relevant to the Grievance. The Employer may call the Employee adversely during its case and question the Employee with leading questions. The parties may cross-examine witnesses presented by the other party. Cross-examination shall be limited to ten (10) minutes per witness unless this time period is extended by the Impartial Hearing Officer The Impartial Hearing Officer is not bound by the rules of evidence and may admit all evidence that the Impartial Hearing Officer determines is relevant and may exclude immaterial, irrelevant or unduly repetitious testimony or evidence. The Impartial Hearing Officer shall recognize the rules of privilege. The Impartial Hearing Officer may not base any finding or conclusion based solely on hearsay evidence. During the hearing, the Impartial Hearing Officer may ask questions as the Impartial Hearing Officer deems necessary. After the Employee and the Employer have finished introducing evidence, the Impartial Hearing Officer shall close the record. The parties shall have no right to file post-hearing briefs or position statements. However, the Impartial Hearing Officer may require the parties to file post-hearing briefs and replies. I. Appeal i The appeal shall be considered by the County Board in closed session pursuant to 19.85 (1)(b) unless the Employee requests, in writing, for the appeal to be heard in open session. Representatives of the Employee and Employer may attend the closed session except for the deliberation of the County Board. The Department of Administration shall send a copy of the agenda to the Employee, and the Employee's representative, if applicable, highlighting the appeal. The County Board shall require a majority vote to uphold, modify, or reverse, the decision of the Impartial Hearing Officer. Grievance Procedure for Employee Terminations and Employee Discipline A. Step 1 An earnest effort shall be made to settle the matter informally between the aggrieved Employee and the Employee's immediate Supervisor and/or Department Head, if there is no Supervisor. If the Grievance is not resolved informally, it shall be reduced to writing by the Employee on the Grievance Form. The Employee shall submit a completed Form to the Department Head with a copy to the Department of Administration-Human Resources Department. The Department Head shall either deny or sustain the Grievance in writing to the Employee. The Department Head shall promptly provide a copy of his or her written determination to the Human Resources Department. Time Limit: If the Employee does not submit a written Grievance to the Department Head within (ten) 10 days of the event(s) giving rise to the Grievance or the date upon which the employee should have first known of said event(s), the Grievance will be deemed waived. The Department Head shall either deny or sustain the Grievance in writing to the Employee within 10 days of receipt of the written Grievance. B. Step 2 If the Grievance is not settled at Step 1, the Employee shall file a completed Request for Hearing Form to the County Administrator requesting a hearing before an Impartial Hearing Officer. Time Limit: If the Employee does not submit a completed form requesting a hearing before an Impartial Hearing Officer to the County Administrator within five (5) days of the Department Head's Decision, the grievance will be deemed waived. If timely requested, the hearing will be scheduled as soon as possible following of receipt of the request for hearing. The Impartial Hearing Officer shall determine whether the Departments Head's decision was arbitrary, capricious or not supported by the facts presented. At the conclusion of the hearing, the Impartial Hearing Officer shall render a written decision indicating the reasons for one of four decisions: 1. Sustaining the discipline/termination, 2. Modifying the discipline/ termination, 3. Denying the discipline/ termination, or 4. Recommending additional investigation prior to final determination. In cases where the hearing officer recommends additional investigation, at the conclusion of the additional investigation, a second, follow-up hearing shall be scheduled. The Impartial Hearing Officer shall have the power to order a reasonable "make whole" remedy. The Impartial Hearing Officer shall render a written decision to the Employer and Employee within 15 days from the date of the hearing. The decision of the Impartial Hearing Officer shall, at a minimum, contain a statement of issues, standard of review, findings and, if the Grievance is sustained, a reasonable "make whole" remedy for the Employee. Burden of Proof. Except in a grievance involving termination of an Employee that is subject to Wis. Admin. Code Chap. DHS 5, the Employee bears the burden of proof by clear, convincing and satisfactory evidence that the County's decision to Discipline/Terminate the Employee was arbitrary and capricious. If the Employee does not satisfy this burden of proof, the Impartial Hearing Officer shall deny the grievance. C. Step 3 The Employer or Employee may appeal the decision of the Hearing Officer to the County Board. The decision of the governing body shall be final and binding upon the parties. The County Board shall not take testimony, accept additional evidence, accept briefing, accept oral argument or otherwise conduct a hearing of any sort in relation to an appeal. Time Limit: The Employee or Employer may request a review by the County Board by filing a request with the County Administrator within 14 days of the written decision of the Hearing Officer. The request must set forth in detail the reasons for the appeal. The non-appealing party shall have 14 days to submit a reply to the detailed request. Once the request for review and reply are received, the review will be scheduled at the board's next regularly scheduled meeting. If not timely submitted, the request to appeal shall be dismissed. Level of Review: The County Board shall review only the written decision of the Hearing Officer, the reasons for the appeal and the reply. The role of the County Board, in reviewing the decision of the Impartial Hearing Officer, is to address the following questions: 1. Did the Impartial Hearing Officer follow a fair and impartial process? i 2. Did the Impartial Hearing Officer make an error of law which makes his/her decision invalid? 3. Did the Impartial Hearing Officer make an error of fact which makes his/her decision invalid? After answering the above questions, the County Board may uphold, modify, or reverse the decision of the Impartial Hearing Officer. The County Board shall deliver a written decision to the Employee and the Employer no later than seven (7) days from the date of the St. Croix County Board Meeting. The written decision shall contain: 1. A statement of the issues, 2. Findings, along with an explanation as to why any findings differ from the Impartial Hearing Officer; and 3. A remedy along with an explanation as to why any remedy differs from the remedy granted by the Impartial Hearing Officer. Grievance Procedure for Workplace Safety A. Step 1 Any employee who personally identifies, or is given information about, a workplace safety issue or incident must notify his/her Supervisor/Department Head of the issue or incident as soon as reasonably practicable. All safety issues, no matter how insignificant the situation may appear to be, must be reported. An Employee shall not file a grievance relating to a condition that the Employee believes constitutes a Workplace Safety violation unless the Employee has first reported the condition to the immediate Supervisor/Department Head in writing on the attached form Appendix 9-E, and promptly send a copy to the Risk Manager. Any workplace safety incident or issue must be reported by an employee within 24 hours after the incident or issue was raised in order to be addressed as part of the grievance procedure. Time Limit: Upon receiving notice of an alleged Workplace Safety violation from an Employee, the Department Head shall have ten (10) days in which to investigate the condition and advise the Employee in writing that the County: (a) has determined that the condition does not constitute a Workplace Safety violation and will not be taking corrective action; or (b) is taking corrective action in accordance with law to address the condition. B. Step 2 If the workplace safety issue is not resolved during Step 1, an employee may initiate a Grievance relating to workplace safety by completing a Grievance Form. The Employee shall submit a completed Form to the Risk Manager with a copy to the Human Resources Department. Time Limit: If the Employee does not submit a written Grievance to the Risk Manager within (ten) 10 days of the Department Head's written determination, the Grievance will be deemed waived. The Risk Manager shall either deny or sustain the Grievance in writing to the Employee within 10 days of receipt of the written Grievance. The Risk Manager shall promptly provide a copy of the written determination to the Human Resources Department. C. Step 3 The employee may appeal the findings and conclusions of the Risk Manager and file a completed Request for Hearing Form to the County Administrator requesting a hearing before an Impartial Hearing Officer. Time Limit: If the Employee does not submit a completed Request for a Hearing Form before an Impartial Hearing Officer to the County Administrator within five (5) days of the Risk Manager's written determination, the Grievance will be deemed waived. If timely requested, the hearing will be scheduled as soon as possible following of receipt of the request for hearing. At the conclusion of the hearing, the Hearing Officer shall record one of three outcomes: 1. Sustaining the conclusions of the Risk Manager, 2. Denying the conclusions of the Risk Manager and ordering additional or alternative remedial measures, or 3. Recommending additional investigation prior to final determination. In cases where the Hearing Officer recommends additional investigation, at the conclusion of the additional investigation, a second, follow-up hearing shall be scheduled The Impartial Hearing Officer shall render a written decision to the Employer and Employee within 15 days from the date of the hearing. The decision of the Impartial Hearing Officer shall, at a minimum, contain a statement of issues, standard of review, findings and, if the Grievance is sustained, a reasonable remedy. Burden of Proof. The Employee shall bear the burden of proof to persuade the Impartial Hearing Officer by clear, convincing and satisfactory evidence that a workplace safety violation has been committed. D. Step 4 The Employer or Employee may appeal the decision of the Hearing Officer to the County Board. The decision of the governing body shall be final and binding upon the parties. The County Board shall not take testimony, accept additional evidence, accept briefing, accept oral argument or otherwise conduct a hearing of any sort in relation to an appeal. Time Limit: The Employee or Employer may request a review by the County Board by filing a completed Request for Appeal Form (Appendix 9-D) with the County Administrator within 14 days of the written decision of the Hearing Officer. The request must set forth in detail the reasons for the appeal. The non-appealing party shall have 14 days to submit a reply to the detailed request. Once the request for review and reply are received, the review will be scheduled at the board's next regularly scheduled meeting. If not timely submitted, the request to appeal shall be dismissed. i Level of Review: The County Board shall review only the written decision of the Hearing Officer, the reasons for the appeal and the reply. The role of the County Board, in reviewing the decision of the Impartial Hearing Officer, is to address the following questions: 1. Did the Impartial Hearing Officer follow a fair and impartial process? 2. Did the Impartial Hearing Officer make an error of law which makes his/her decision invalid? 3. Did the Impartial Hearing Officer make an error of fact which makes his/her decision invalid? After answering the above questions, the County Board may uphold, modify, or reverse the decision of the Impartial Hearing Officer. The County Board shall deliver a written decision to the Employee and the Employer no later than seven (7) days from the date of the St. Croix County Board Meeting. The written decision shall contain: 1. A statement of the issues; 2. Findings, along with an explanation as to why any findings differ from the Impartial Hearing Officer; and 3. A remedy along with an explanation as to why any remedy differs from the remedy granted by the Impartial Hearing Officer. Appendix 9-A DISCIPLINE/TERMINATION GRIEVANCE FORM PLEASE FILL OUT THIS FORM COMPLETELY. IF YOU NEED MORE SPACE, ATTACH ADDITIONAL SHEETS OF PAPER. Name of Grievant: Work Phone: Department: Home/Cell Phone: Job Title: Home Mailing Address: DATE AND TIME RECEIVED (for County use only) 1. Discipline/Termination Being Grieved. Provide a description of the discipline/termination being grieved. 2. Basis For Grievance. Provide a detailed description of the reason or reasons why you believe that the County's decision to discipline or terminate you was incorrect and should be overturned and a detailed description of any facts or information which support your belief. 3. Witnesses. Identify by name, telephone number and address of all witnesses that you believe will support your claim that the County's decision to discipline or terminate you was incorrect and should be overturned. Provide a summary of the facts and/or information known by each witness. 4. Documents. Attach any documents which support your claim that the County's decision to discipline or terminate you was incorrect. If you do not have a document, provide a description of the document which includes date of the document, the source of the document and the content of the document. 5. Remedy Requested. Describe in detail how you believe the County's disciplinary action or termination should be modified. 6. Certification and Signature. By my signature below, I certify that 1 have read the above complaint and, under penalty of law, 1 declare that this complaint is true and correct. Signature of Employee: Date Signed: INSTRUCTIONS 1. USE: This grievance form is for use in connection with the St. Croix County Grievance Policy. Only those employees who meet the definition of "Employee" in the Grievance Policy may file a Grievance. This grievance form may be used only in connection with "discipline" and "termination" as defined by the Grievance Policy. Please refer to the Grievance Policy for additional rules and restrictions. 2. FILLING OUT THE GRIEVANCE FORM a. Event Being Grieved. This section requires you to describe the disciplinary act or termination that you are grieving. The description should include the reason(s) you understand you were disciplined/terminated and the date on which the discipline/termination occurred. A grievance form may only address one disciplinary event. b. Basis for Grievance. This section of the form requires you to provide a detailed description of the reason or reasons why you believe that the County's decision to discipline or terminate you was incorrect. Single word or limited responses to the effect that the discipline/termination was "wrong," "unfair," "unequal" or "mistaken" are insufficient. You must provide a detailed response explaining why you believe the disciplinary action or termination taken by the County was incorrect or unreasonable and a detailed description of any facts, events or other information which support your belief. Note that under the Grievance Policy, you will have the burden of proving by clear, convincing and satisfactory evidence that the County did not have a rational basis for the disciplinary action/termination. C. Witnesses. This section of the form requires you to identify all witnesses who you believe will support your claim that the disciplinary action or termination taken by the County was incorrect. The last known telephone number and address of each witness must be provided. You are also required to provide a detailed description of the facts or information known by each witness that supports your claim that the disciplinary action or termination taken by the County was incorrect and should be overturned. Single word or limited descriptions to the effect that the witness knows the discipline/termination was "wrong," "unfair," "unequal" or "mistaken" are insufficient. Employees must provide a detailed description of the facts or information known by each witness. d. Documents. This section of the form requires you to produce all documents you believe support your claim that the disciplinary action or termination taken by the County was incorrect. If you do not have the documents, you are required to provide a description of each document which includes the date of the document, the source of the document and a description of the contents. The source can be, for example, an e-mail from a department head, supervisor, co- worker or other individual, a County policy or communication, a time card, portions of an employee or county file or a document that you wrote. The description of the contents should include the subject of the document and the information in the document which you believe supports your position on the grievance. e. Remedy Requested. This section requires you to describe how you believe that the discipline or termination should be changed. The remedies that are available under the Grievance Policy are limited. 3. ASSISTANCE: All information on the grievance form must be provided. If you have any questions regarding the information required by the form, please contact The Department of Administration-Human Resources Department. The Human Resources Department cannot provide you with legal advice in connection with your grievance. Employees are encouraged to consult an attorney of their choice with any legal questions. Appendix 9-B EMPLOYEE WORKPLACE SAFETY GRIEVANCE E® PLEASE FILL OUT THIS FORM COMPLETELY. IF YOU NEED MORE SPACE, ATTACH ADDITIONAL SHEETS OF PAPER. Name of Grievant: Work Phone: Department: Home/Cell Phone: Job Title: Home Mailing Address: DATE AND TIME RECEIVED (for County use only) 1. Identification of Condition Being Grieved. Provide a description of the Workplace Safety condition being grieved. 2. Basis For Grievance. Provide a detailed description of a workplace safety standard you believe has been violated and a detailed description of any facts or information which support your belief. 3. Witnesses. Identify by name, telephone number and address of all witnesses that you believe will support your claim that the County has violated a workplace safety standard. Provide a summary of the facts and/or information known by each witness. 4. Documents. Attach any documents which support your claim. If you do not have a document, provide a description of the document which includes date of the document, the source of the document and the content of the document. 5. Remedy Requested. Describe in detail the remedy you request. 6. Certification and Signature. By my signature below, I certify that I have read the above complaint and, under penalty of law, I declare that this complaint is true and correct to my knowledge and belief. Signature of Employee: Date Signed: INSTRUCTIONS 1. USE: This Workplace Safety grievance form is for use in connection with the St. Croix County Grievance Policy. Only those employees who meet the definition of "Employee" in the Grievance Policy may file a Grievance provided that the hazard or condition which is the subject of the grievance constitutes a "Workplace Safety" violation and the Employee has complied with the conditions for filing a Workplace Safety grievance outlined in the Grievance Policy. An Employee does not have to be personally impacted by a claimed hazard or condition in order to file a Workplace Safety grievance. Please refer to the Grievance Policy for additional rules and restrictions. 2. FILLING OUT THE GRIEVANCE FORM. a. Condition Being Grieved. This section requires you to describe the Workplace Safety hazard or condition that you are grieving. A grievance form may only address one Workplace Safety hazard or condition. b. Basis for Grievance. This section of the form requires you to provide a detailed description of the standard or standards that you believe the hazard or condition violates. The description must include an explanation as to how the hazard or condition constitutes a workplace safety violation. Single word or limited responses simply indicating that the hazard or condition are insufficient. Note that under the Grievance Policy, you will have the burden of proving by a preponderance of the evidence that the condition constitutes a Workplace Safety violation and that corrective action by the County is required. C. Witnesses. This section of the form requires you to identify all witnesses who you believe will support your claim. The last known telephone number and address of each witness must be provided. You are also required to provide a detailed description of the facts or information known by each witness that supports your claim. You must provide a detailed description of the facts or information known by each witness. d. Documents. This section of the form requires you to produce all documents you believe support your claim. If you do not have the documents, you are required to provide a description of each document which includes the date of the document, the source of the document and a description of the contents. The source can be, for example, an e-mail from a department head, supervisor, co-worker or other individual, a County policy or communication, a time card, portions of an employee or county file or a document that you wrote. The description of the contents should include the subject of the document and the information in the document which you believe supports your position on the grievance. e. Remedy Requested. This section requires you to describe your opinion on the appropriate remedy. 3. ASSISTANCE: All information on the grievance form must be provided. If you have any questions regarding the information required by the form, please contact The Department of Administration-Human Resources Department. The Human Resources Department cannot provide you with legal advice in connection with your grievance. Employees are encouraged to consult an attorney of their choice with any legal questions. Appendix 9-C REQUEST FOR HEARING F® INSTRUCTIONS: This form is to be used by employees to appeal the written decision of the department head relating to discipline or termination; or the Risk Manager relating to workplace safety by requesting a Hearing under the St. Croix County Grievance Policy. You may only use the space provided on this form. Name of Employee: Work Phone: Department: Home/Cell Phone: Job Title: Home Mailing Address: DATE AND TIME RECEIVED (for County use only) 1. Decision From Which a Hearing is Requested. Attach a copy of the department head/Risk Manager's decision to this form. 2. Basis For Hearing Request. Describe why you believe the decision of the department head or Risk Manager was incorrect. 3. Remedy. Describe what you believe the department head/Risk Manager should have ordered and why. Signature of Requesting Party: Date Signed: Appendix 9-D REQUEST FOR APPEAL FORM INSTRUCTIONS: This form is to be used by employees and/or the County to appeal the written decision of an Impartial Hearing Officer relating to discipline, termination or workplace safety under the St. Croix County Grievance Policy. You may only use the space provided on this form. Name of Employee: Work Phone: Department: Home/Cell Phone: Job Title: Home Mailing Address: DATE AND TIME RECEIVED (for County use only) 1. Decision From Which An Appeal Is Being Taken. Attach a copy of the impartial hearing officer's decision to this form. If you do not have a copy, provide the date of the decision, the name of the Impartial Hearing Officer and briefly describe the decision and order of the impartial hearing officer in the space below. 2. Basis For Appeal. Describe why you believe the decision of the impartial hearing officer was incorrect. 3. Remedy. Describe what you believe the impartial hearing officer should have ordered and why. Signature of Appealing Party: Date Signed: Appendix 9-E ST. CR.OIX COUNTY SAFETY CONCERN REPORTING FORM Individual Observing Safety Concern: Address: Phone: Department: Date: Location of Observed Safety Problem: Witness: Witness: Witness: Witness: Brief Description of Problem or Incident: Supervisor to Whom Forwarded: Date: Copies: Risk Management Supervisor Employee 0 0~ v 0 v v o 0 o e e ~ e e e o e e ° t 1~a ~ m 5 4 tsr r' ha d to ei r.F Imo- .rc{ _ ~ 9,.7 Action Taken: Date of Action: Suggestions and/or Possible Solutions: Supervisor - Send Copy to Risk Manager Indicating Action Taken and Retain a Copy for Files.