Coronavirus Health & Safety Reporting Form If you are a member with a COVID-19 concern in your workplace, please report it to us using the form below. Help us keep track of the problems you are facing so we can better work with employers to address them. Name* First Last Phone*Email Employer*Please select your employer from the drop-down menu. If your employer is not listed, select "OTHER" at the bottom of the list.A.M. BriggsACE SushiAnnapolis City PoliceAssoc. Administrators, Inc.Barbers & BeauticiansBelpre City PoliceBernie 2020 Inc.Bestway FoodBethesda Co-OpBloomingdalesBoar’s Head ProvisionBrooks BrothersClearon CorporationClinton Nursing & Rehabilitation CenterCVS PharmacyDanChem Technologies, Inc.Dr. Pepper, 7-up Bottling Co.E&R Sales and Marketing Services, Inc.Elizabeth Adam Crump Nursing Home (Golden Living)EMD Sales, INc.Ennis Business Forms, Inc.Giant FoodGino Morena Ent.Hinchcliff Lumber Co.Kaiser PermanenteKey & AssociatesKrogerLiptonMacy’sMetropolitan PoultryMontgomery General Elderly CareOmega ProteinPeaPod.comRes-care Inc.Restaurant DepotSafewayShoppers Food & PharmacySmithfield Distribution CenterTakoma Park Police Dept.Tyson Foods, Inc.UFCW InternationalWestbrook Health ServicesOTHERWorkplace Location or Store Number* Please describe your concerns in detail and a union representative will follow up with you.*Are you experiencing a problem? Do you have a question? Do you have a suggestion? Please let us know in detail. It is better to give too much information than not enough.Have you brought your concerns to management?* Yes No How did management react when you raised your concerns?Please describe the interaction in detail and include the name of the manager, and the date & time of when you spoke. Photo Evidence (Optional)Please submit any photo evidence about your concerns (optional). Drop files here or Select files Max. file size: 100 MB. Do you have any comments, questions, or other relevant information to share?PhoneThis field is for validation purposes and should be left unchanged.