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​​ Bureau of Mediation


Following is a list of interactive PDF forms pertaining to labor/management services available through the Department of Labor and Industry. If an alternate version of a form is needed, please contact the Bureau of Mediation at 717-787-2803.

Title/Description L&I Form
Dispute Notice LIMS-102
Pennsylvania Public Employe Relations Act (195) Notice to Bureau of Mediation LIMS-103
ACT 88 Amendment to the Public School Code of 1949 Notice to Bureau of Mediation
Act III Police & Fire
Request for Grievance Arbitration Panel LIMS-115
Request for Grievance Mediation LIMS-117
Joint Request for Voluntary Card Check LIMS-126​

Using electronic Fill-in-the-Blank PDF Forms:

NOTE: Use of PDF Fill-in-the-Blank forms does NOT include online submittal. In addition, completed PDF forms cannot be saved or attached to e-mail messages.

This PDF form is available in a fill-in-the-blank format. Users now have the option to complete the PDF forms electronically, instead of manually writing or typing the information on a hard copy version.

The form can be completed in several easy steps.

  • The user opens the PDF form in Acrobat Reader—in the browser or as a standalone product. The user can also save the “blank” PDF form to their computer system and open the form in Acrobat Reader at a later time.
  • Once the form is open, the user clicks on the desired entry field and a blinking cursor appears.
  • After the information has been entered in the entry field, the user can tab to the next field.
  • After all the fields have been completed, the user can print out the page.
  • If this form is accessed through a shared PC, it may be necessary to clear information from the form before beginning. Form fields can be cleared by selecting the "Clear All Fields" button at the top of the form.

NOTE: If the cursor is blinking in a field, the information in that field will not be printed. Hit your "Return" or "Enter" key and the information will be captured for all completed fields.

Users with Adobe Acrobat Professional as opposed to the Free Acrobat Reader, can save entered data for later use as well as submit completed forms via email.

Accessibility Information:

This form is designed to be accessible by persons with disabilities that utilize assistive technology such as Screen Readers. However, if personal assistance is required, please contact the Bureau of Mediation for assistance.