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Labour Relations - Preventive Mediation Request Form

To: Director,  
Labour Relations Division
Date:
Subject: Request for Preventive Mediation Services

(Complete, print and send this form to the address provided below, or complete the form and click on the submit button to send it electronically)

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Mediator assistance is requested under the Preventive Mediation Program as follows:

Mediator Consultation
First Agreement Orientation
Labour Management Committee
Joint Problem Solving Training
Relationship By Objectives
Interest Based Negotiation
Workplace Intervention
Grievance Mediation (identify grievance)
Is this a joint request?	Yes  No
Have other party been notified of this request?	Yes  No
Name of party making request
Mailing Address
Postal Code
Contact person's name
Title
Telephone
Fax
Name of other party
Mailing Address
Postal Code
Contact person's name
Title
Telephone
Fax
Further Comments:
Government of Newfoundland and Labrador Labour Relations Agency Labour Relations Division 3rd Floor Beothuck Building, 20 Crosbie Pl. P.O. Box 8700 St. John's, Newfounfland A1B 4J6 Telephone: (709) 729-2711 Fax: (709) 729-5905

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