CROSS JURISDICTION
FORM |
Questions marked by * are required.
If you do not know the answer, please type "Unknown." |
1. |
Location of Incident: *
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2. |
Your Name: *
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3. |
Your Home Phone Number: *
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4. |
Your Personal Email: *
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5. |
Contracts involved: *
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6. |
Contracts Employees Working in: *
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7. |
Department Working in: *
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8. |
Department Employee is Coming From: *
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9. |
Supervisor of the Area Where the Work is Being Performed:
*
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10. |
Supervisor’s Phone Number: *
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11. |
Name of the Supervisor Whose Employee is Working in the Area:
*
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12. |
Telephone Number of the Supervisor: *
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13. |
Type of Work Performed: *
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(Once submitted, a copy of the answers will be sent to the
email address you provided.)
RLS/jl opeiu3, afl-cio
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