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CWA Safety and Health Complaint Form
Communications Workers of America

Questions marked by * are required.

I hereby submit a formal report of an unsafe or a hazard working condition on this


Date: *
,  on behalf of Local: *
Employer Name: *
Location: *
Work Area: *
Describe the Hazard: *
Action Needed to Correct the Hazard: *
Manager's Name and Phone Number: *
Your Name: *
Email: *
Your Phone Number: *
  

(Once submitted, a copy of the answers will be sent to the email address you provided.)

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Copyright 2014 Communications Workers of America - District 7
For problems or questions regarding this web contact
Rick Sorensen or Jay Lute
Last updated: June 2, 2014.