Accredited Representative Report Form

This form is to be used by an Accredited rep following a representation meeting they have attended with a member, as allocated by the casework team.

Accredited Rep Report Form

Accredited Representative's Name *:
Accredited Representative's Membership Number *:
Member's name *:
Member's Membership Number *:
Case Type *:

Disciplinary

Grievance

Other
Short description of the case (this does not need to be longer than a paragraph) *:
Outcome or Sanction *:
Was the member dismissed? *:

Yes

No
Dismissal date:
Any other possible limitation dates e.g. for discrimination claims/unlawful deductions from wages/breach of contract/whistleblowing etc *:
What follow up action is required in this case? *:
Do you believe there are any recruitment/organising opportunities in this workplace? *:

Yes

No

Maybe
Please provide details of the recruitment/organising opportunities:

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GMB Southern Region