Investigation Fact Sheet
DEPARTMENT
__________
DATE ___________________
SHIFT
__________
STEWARD ________________
NAME(S) OF
EMPLOYEE (S) _____________________________________________
CLASSIFICATION___________
SENIORITY
DATE__________
WHAT HAPPENED:
EMPLOYEE(S) STORY: ACCOUNT
DATE OF
INTERVIEW WITH EMPLOYEE(S) __________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
WHEN:
______________________
WHERE
____________________
SUPERVISOR’S NAME
________________ DATE_______ SUPERVISOR’S STORY:
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
WHEN:
______________________
WHERE
____________________
ALLEGED
CONTRACT/RULE/MAJOR/MINOR VIOLATION _______________________
WITNESS NAMES
__________________ WHAT THEY WITNESSED
________________
__________________
________________
__________________
________________
__________________
________________
DOCUMENTS
NEEDED:
(CHECK WHEN
RECEIVED AND ATTACH TO THE FACT SHEET)
____ATTENDANCE
RECORD ____MEDICAL
RECORD
____WORK RECORD
____BREAK
SHEETS
____COPY OF CONSULTATION ____OTHER
USE BACK OF
THIS FORM TO RECORD ADDITIONAL INFORMATION
Remember the TIME LIMITS…. Keep track of when the
violation occurred, and the time limits in your
contract!