BMWED/IBT Local 2405 Preliminary Form for Claims and Grievances   Time limits start on the day of the action in question (rule violation).  Remember, this form is for union use only.  Do not submit it to the company or you may subject yourself to needless harassment by supervisors or officials.  The time clock is running, so mail or fax this form to your Local Chairman or System Office as soon as possible.  The success or failure of your claim may depend on the timeliness and accuracy of the information you provide:   1.  Who are you?  We need the details.  Name of Claimant:___________________________________________________________  Social Security Number:___________________Employee Number____________________  Phone Number:  (       )____________________Cell:  (       )_________________________  Address:  __________________________________________________________________  Position:_________________Gang Number:_____Headquarters:______________________  Assigned Hours:__________________________Work Week:________________________  Seniority Dates:  (position)______________________________(date)__________________                           (position)______________________________(date)__________________  Date Furloughed (If applicable):_________________________________________________ 2.  What Happened?  Tell us what the company did to violate the Agreement, Awards, or work rules.  ___________________________________________________________________________  ___________________________________________________________________________  ___________________________________________________________________________  ___________________________________________________________________________ 3.  When did this happen?  We need more details.  Date(s) of violation:___________________________________________________________  Time:  (From)_______________(To)________________How many hours?______________  Is this a continuing claim?______Yes_____No 4.  Where did this happen?  Be as specific as possible.  Mile post location:_________Nearest Station:___________________District:____________  Town:_________________________________________State:________________________ 5.  Why should this violation be considered as a claim or grievance?  Agreement rules or awards violated:_____________________________________________  What compensation are you seeking for your claim?________________________________  ___________________________________________________________________________  ___________________________________________________________________________  ___________________________________________________________________________ Does anyone else want to be included in this claim? Name:__________________Address:______________________Phone: (       )___________ Name:__________________Address:______________________Phone: (       )___________ Name:__________________Address:______________________Phone: (       )___________ Name:__________________Address:______________________Phone: (       )___________ IMPORTANT!!!  Were there any witnesses? Name:__________________Address:______________________Phone: (       )___________ Name:__________________Address:______________________Phone: (       )___________ Name:__________________Address:______________________Phone: (       )___________ Name:__________________Address:______________________Phone: (       )___________ Signed(filing claimant):_________________________________Date:______________ Local Representative:___________________________________Date:______________ Now, we have tried to think of everything that would be helpful in furthering your claiim.  But, if we have forgotten something, or you think of something that could be helpful, write it down.  Having a representative present at every instance of a violation is impossible.  So, the information we have is what we have to go with.  There are strict time limits in all phases of claim processing, so hurry every chance you get.  And, don't hesitate to attach some more pages if you need more space.  Call or email one of the officers listed on the Local 2405 Officers page or the System Federation page if you have questions or need help. For easy access, click on either the icon or the highlighted phrase below to download a claim and grievance form to your computer.  If you follow the instructions carefully, you will have the claim and grievance form on your computer.    Download and SAVE Claim and Grievance Form   If the claim and grievance form downloads correctly, you have several options. You can simply print the form for personal use or distribution to other members. You can fill out the form on your computer and email the form to a Local 2405 Officer. You can also be fax the completed form to the Federation Office in Newton. If the form will not download, Just use the "Edit" function of your browser or word processor to "copy" and "paste" the above claim and grievance form into the word processor on your computer. Important...Be sure to keep a copy of all correspondence as proof of your claim or grievance.   Provided as a service of Local 2405. Serving the needs of our members...FIRST!