Coronavirus Health & Safety Reporting Form

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.
Workplace 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

Max. file size: 100 MB.
Do you have any comments, questions, or other relevant information to share?
Phone
This field is for validation purposes and should be left unchanged.