Helping you resolve your workplace issues

Your name *

Your workplace *

Your contact email address *

Mobile

Your issue

The circumstances *Briefly explain the circumstances of your issue, specifically what has happened and who is involved. Please include known dates, places and any relevant details that explain your situation.

Have you discussed the issue with your ‘one-up’ manager? *

YesNo

What was the outcome of your 'one-up' manager discussion *

Have you discussed the issue with another decision maker or HR? *

YesNo

What was the outcome of your HR/decision-maker discussion? *

Have you discussed the issue with your local CPSU delegate, Health and Safety Representative or Harassment/Equity officer? *

YesNo

What was the outcome of the discussion with your local CPSU delegate, HSR or Harassment/Equity officer? *

Have you made a complaint to another agency (eg Australian Human Rights Commission, Fair Work Commission, Workers’ Compensation Agency)? *

YesNo

Please give further details of the complaint and any outcome to date *

Have you employed an external representative to assist you in resolving the grievance (eg solicitor, advocate, mediation firm)? *

YesNo

Please give details of who is involved, what involvement they have had and any outcome to date *

How has the issue affected you? *Please select all that apply

Other effect *

What outcome do you want? *

Final comments

Supporting evidence

Do you have any of the following documentation to support your issue? If yes, please attach copies to this form.

Other supporting evidence *

Attach medical cerificate/s *

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Attach performance reviews/plans *

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Attach any written directives *

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Attach any witness statements *

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Attach any notification/outcomes of misconduct investigation *

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Attach any tribunal/panel decisions *

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Attach any pay slips *

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Attach other evidence *

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Privacy statement: In providing us this information you agree to the CPSU collecting this information and handling it in accordance with our privacy policy. You can access our privacy policy online, including information on use, disclosure, security, access, correction and complaints, or by calling 1300 137 636.