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