** Where input is necessary
*** If applicable
**** Use one or the other possibility given in between the asterisks
Date of report: **date**
Assignment No.: **Auto fill**
Employer No.: **Auto fill**
Site No.: **Auto fill**
****Employer or Director or Directors****: **Corporate Name or Director(s) Name, address, telephone and fax numbers**
****Employer's or Director's or Directors'**** Legal Counsel: **Name, address, telephone and fax numbers**
****Complainant or Complainants****: **Name, address, telephone and fax numbers**
****Complainant's or Complainants'**** Legal Counsel: **Name, address, telephone and fax numbers**
The appeal request was filed by the **indicate who filed the appeal**.
This appeal request is the result of a ****payment order or notice of unfounded complaint**** issued on **date**.
The ****payment order or notice of unfounded complaint**** was issued on **date**, and sent to the ****employer or director or directors**** and ****complainant or complainants**** on **date** by ****registered mail or personal service****. The ****payment order or notice of unfounded complaint**** was received by the ****employer or director or complainant**** on **date**. The written appeal request in regards to the ****payment order or notice of unfounded complaint**** was received on **date**, ***the envelope post mark date, if necessary*** which ****is or is not**** within the required 15-day appeal period.
***Did the written appeal request for payment order include payment: ****yes or no****
Date payment received: **date**
Were deductions made pursuant to subsection 254.1(2): ****yes or no****, **explain**.***
The appeal is therefore ****admissible or inadmissible**** as per section 251.11 of the Canada Labour Code Part III.
**Use this space to clarify preliminary issues decided, such as jurisdiction of the employer, managerial status and employer/employee relationship. Make appropriate Code reference.**
**This should be a clear and concise statement outlining the issue(s) which form the basis of the dispute between the parties. Reference the sections of the Code or the Regulations which should also be contained in the payment order or notice of unfounded complaint.**
**State the employer's position in regards to the allegations.**
**State the position of the complainant as it pertains to the allegations.**
**This section should be a complete analysis of the issue(s) in dispute and their relation to the merits of the case. All relevant facts of the investigation should be cited from the inspection's investigation and describe how these pertinent facts lead to the final resolution. The inspector should set out the evidence received and the applicable sections for each issue in dispute. The applicable sections of the Code and Regulations from the payment order or notice of unfounded complaint should be referenced. If any of the OPDs, IPGs, or case law was cited, the inspector should cite the portion of the decision, etc. that impacts the case and attach copies.
This section should not be used as a rebuttal of the grounds for appeal, and any additional evidence raised after the date of the payment order or notice of unfounded complaint should be directed to the referee by the party.**
****In view of the above circumstances, I have determined that the ****employer or director or directors**** ****owes or owe**** the ****complainant or complainants**** a total of $**amount** for non-payment of **type**, and ****a payment order or payment orders**** ****was or were**** issued on **date**. The **indicate who filed the appeal** ****has or have**** appealed this order.
or
In view of the above circumstances, I have determined that the complaint of **name of complainant** against **name of employer** is unfounded and a notice of unfounded complaint was issued on **date**. The ****employer or complainant or employer and complainant**** ****has or have**** appealed this order.****
The employer has requested that the hearing be held in
**Name of inspector**, Inspector
****Complete address if not shown on letterhead****
Telephone Number: **Telephone Number**
Fax Number: **Fax Number**
Original of the appeal request
***A copy of the ****cheque or money order**** ***
Referee copy of the ****payment order or notice of unfounded complaint****
Canada Post Corporation receipt for registration
Canada Post Corporation Certificate of Delivery Confirmation
Certificate of the Minister of Labour, Appendix F
A copy of the complaint
***Copy of any OPDs, IPGs, and case law cited in the report***