MONTHLY
PEIR REPORTING FORM
Revised 12/19/14

***Due the 15th of each month***

Last Name____________________________First Name________________________
City__________________________________State______Wk. Tel_________________
Month_______________   Year________________

Email to: Sue Head: shead@cwa7019.org.
If you have no activity to report, or if questions arise call  602-630-2623 (Local phone.)

Contact Information 

Number of Contacts with employees 		Company Time		Personal Time      	 

		_________         				_____________		____________	

Number of Consultations (w/Mgmt or Union)	Company Time		Personal Time

		__________					_____________		____________

Number of Presentations 				Company Time		Personal Time

	___________					_____________		____________

Number of PEIR meetings				Company Time		Personal Time

	___________					_____________		____________

Additional Comments: Please include any changes to personal information ie address change, phone number change, change in employment status, etc