Form R-19 Arbitrator's Report and Fee Statement

FEDERAL MEDIATION AND CONCILIATION SERVICE
Washington, DC 20427
FMCS Form R-19
Revised January 2003
Fax: (202) 606-3749

ARBITRATOR’S REPORT AND FEE STATEMENT

Form Approved
OMB No. 3076-0003
Expires 01-31-06

FMCS Case # ____________________ ARBITRATOR __________________________DATE OF AWARD_________

I. EMPLOYER ____________________________ II. UNION
III. ISSUES
a.

____________________________________

(Please check either a or b, and complete c and d)

New or reopened contract terms

c. Was arbitrability of grievance involved?
(If YES, check one or both)

b.

Contract interpretation or application
Yes

No

Procedural

Substantive

d. Issue
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.

or Issues (Please check only one issue per grievance)
Affirmative Action
18.
Management Rights
Absenteeism
19.
Official Time
Arbitrability
20.
Past Practices
Bargaining Unit Work
21.
Pension and Welfare Plans
Conduct (Off-Duty/Personal)
22
Pension Claim (Federal Statute)
Demotion
23.
Promotion
Discipline (Non-Discharge)
24.
Retirement
Discipline (Discharge)
25.
Safety/Health Conditions
Discrimination (Any type)
26.
Seniority
Fringe Benefits
27.
Sexual Harassment
Grievance Mediation
28.
Strikes/Lockouts, Work
Health/Hospitalization
Stoppages/Slowdowns
Hiring Practice
29.
Subcontracting/Contracting Out
Job Performance
30.
Tenure/Reappointment
Job Posting/Bidding
31.
Wages (Overtime, Holiday pay, etc.)
Jurisdictional Dispute
32.
Work Hours/Schedules/Assignments
Layoffs/Bumping/Recall
33.
Working Conditions/Work Orders
34.
Violence or Threats
IV. HEARING
a. Were briefs filed? YES
NO If YES, give date ________ b. Was transcript taken
YES
N0
c. No. of Grievances heard: ________ d. Date of hearing: ____________ e. Date of grievance: ____________
f. Extension granted by either party on initial award date?
YES
NO
V. FEES AND DAYS FOR SERVICES AS AN ARBITRATOR:
0.0
# OF DAYS:_________ + __________+ __________= ___________
X
Hearings

Travel

Study

Total

0.00
$ _____________ = $ _________

Per Diem Rate

EXPENSES: Transportation: $___________________ + Other: $_______________=

Total Fee

0.00
$_________________________

Total Expenses
Amt. Payable by Company:

$____________________

Amt. Payable by Union:

$ ________________

VII. Cancellation Fee Only: __________

VI. Panel: If tripartite panel or more than one arbitrator made the award, check here:
VIII. DATE of this Report: ________________________ Signature: ____________________________________
PAPERWORK REDUCTION ACT NOTICE: The estimated burden associated with this collection of information is 30 minutes per respondent. Comments
concerning the accuracy of this burden estimate and suggestions for reducing this burden should be sent to the Director of Arbitration Services, Federal Mediation
and Conciliation Service (FMCS) 2100 K Street, N.W., Washington, DC 20427. Persons are not required to respond to this collection of information unless it displays
the currently valid OMB control number.