AD HOC GRIEVANCE ARBITRATOR’S FEE AND EXPENSE REPORT
	
Arbitrator Name		
A/P No.		
Employer Name		
Employer Address		
Labor Organization Name		
Labor Organization Address		
Date(s) of Hearing		
Location(s) of Hearing		
Was Case Resolved:	
  Prior to Hearing
  During Hearing	
Was a Transcript Taken?	
  Yes
  No	
If Yes, Date Transcript Received		
Were Briefs Filed?	
  Yes
  No	
If Yes, Date Last Brief Was Received		
Was There Any Waiver by Parties on the Date the Award Was Due?	
  Yes
  No
  No Contractual Requirement	
Date of Award		
Fees	
    Daily Per Diem Fee		
    Travel		
    Expenses		
    Award Preparation		
Total Fees		
Amount Payable by Employer		
Amount Payable by Labor Organization		
Date of This Report		
Signature		

PLEASE ATTACH A COPY OF THE AWARD TO THIS FEE AND EXPENSE REPORT, IF ANY, AND MAIL, FAX OR E-MAIL TO THE WISCONSIN EMPLOYMENT RELATIONS COMMISSION, 2418 CROSSROADS DRIVE, SUITE 1000, MADISON, WI  53718-7896, FAX: 608-243-2433, EMAIL: WERC@WERC.STATE.WI.US.  
PLEASE BE ADVISED THAT YOUR AWARD BECOMES A MATTER OF PUBLIC RECORD UPON RECEIPT BY THE COMMISSION.