| |
Previous Section | Table of Contents | Next Section
APPENDIX A: THE SURVEY FORM
Mediation (Personal Grievances) survey 17 July to 11 August 2006
Please fill in one of these forms for each Personal Grievance you mediate for the survey dates. Your assistance with this survey is appreciated.
1. Personal Grievance requiring mediation
- Constructive Dismissal
- Discrimination
- Duress
- Harassment
- Redundancy
- Unjustifiable action
- Unjustified Dismissal
- Other (please state)
2. How many employees are in the organisation that the Applicant is employed by?
- between 1-5 employees
- between 6 and 19 employees
- between 20 and 49 employees
- between 50 and 99 employees
- between 100 and 499 employees
- 500 or more employees
3. Are the Terms of Employment?
- Fixed term
- Permanent
- Independent contractor
- Other (please state)
4. Length of time Applicant employed by this employer? (Tick one only)
5. Does the Applicant work?
- Full time
- Part time
- On a casual basis
6. Did the Applicant have representation?
Respondent have representation?
7. If yes to question 6, was the representative:
Applicant
- Union Representative
- Lawyer/Barrister/Solicitor
- Employment Advocate
- Family/friend
- Other (please state)
Respondent
- Union Representative
- Lawyer/Barrister/Solicitor
- Employment Advocate
- Family/friend
- Other (please state)
8. Was this dispute settled with an agreement at this meeting?
- Yes
- Partially settled
- No
- Don't know
9. Compensation agreed at settlement?
- Nil
- Up to $500
- Over $500 and up to $1000
- Over $1000 and up to $2000
- Over $2000 and up to $5000
- Over $5,000 and up to $10,000
- Over $10.000 and up to $30,000
- Over $30,000 and up to $50,000
- Over $50,000
10. Other components of the settlement? (Please tick all that apply)
- Apology
- Certificate of Service
- Legal costs (state amount)
- Notice
- Reference
- Reinstatement
- Resignation
- Wages (state amount)
- Other (please state)
Demographic information11. Is the Applicant
12. Within which age group is the Applicant?
- 15-17 years
- Over 17 and up to 20 years
- Over 20 and up to 25 years
- Over 25 and up to 40 years
- Over 40 and up to 65 years
- Over 65 years
13. What ethnic group is the Applicant?
- NZ European
- Other European
- NZ Maori
- Pacific Peoples
- Asian
- Middle Eastern/Latin American/African
- Other (please state)
14. Industry group: Please tick the box that most closely represents the Applicants workplace industry group
Accommodation, Cafes and Restaurants
- Accommodation
- Cafes and Restaurants
- Clubs (Hospitality)
- Pubs, Taverns and Bars
Agriculture, Forestry and Fishing
- Agriculture
- Commercial Fishing
- Forestry and Logging
- Hunting and Trapping
- Services to Agriculture, Forestry, and Fishing
Communication Services
- Postal and Courier
- Telecommunications
Construction
- Construction Trade Services
- General Construction
Cultural and Recreational Services
- Libraries, Museums and the Arts
- Motion Picture, Radio and Television Services
- Sport and Recreation
Education
- Adult, Community and Other Education
- Preschool and School Education
- Tertiary Education
Electricity, Gas and Water Supply
- Electricity and Gas Supply
- Water Supply, Sewerage and Drainage Services
Finance and Insurance
- Finance
- Insurance
- Services to Finance and Insurance
Government Administration and Defence
- Defence
- Foreign Government Representation
- Central Government Administration
- Local Government Administration
- Justice
Health and Community Services
- Child Care Services
- Community Care Services
- Hospitals and Nursing Homes
- Medical and Dental Services
- Other Health Services
- Veterinary Services
Manufacturing
- Food, Beverage and Tobacco
- Meat/ meat product processing and manufacturing
- Machinery and Equipment Manufacturing
- Metal Product Manufacturing
- Non-Metallic Mineral Product Manufacturing
- Other Manufacturing
- Petroleum, Coal, Chemical and Associated Product
- Manufacturing
- Printing, Publishing and Recorded Media
- Textile, Clothing, Footwear & Leather Manufacturing
- Wood and Paper Product Manufacturing
Mining
- Coal Mining
- Metal Ore Mining
- Oil and Gas Extraction
- Other Mining
- Services to Mining
Personal and Other Services
- Interest Groups
- Personal Services
- Public Order and Safety Services
- Private Households Employing Staff
Property and Business Services
- Business Services
- Property Services
Retail Trade
- Food Retailing
- Motor Vehicle Retailing and Services
- Personal and Household Good Retailing
Transport and Storage
- Air and Space Transport
- Other Transport
- Rail Transport
- Road Transport
- Services to Transport
- Storage
- Water Transport
Wholesale Trade
- Basic Material Wholesaling
- Machinery and Motor Vehicle Wholesaling
- Personal and Household Good Wholesaling
Previous Section | Table of Contents | Next Section
|
 |
