Local 194 is asking that you summit this form to us if you have a problem with a
supervisor please return this form to Bob Holbrook or Sam Lynch Promptly.
Name:__________________________________________________________________
Work Locaiton:___________________________________________________________
Date of Complaint:________________________________________________________
Name of official:__________________________________________________________
Nature of complaint:
_______Did not answer a request for time off
_______Denied a request for time off to go to the doctor
_______Denied a request for a single day vacation when the allotment was not filled
_______Ordered you to go outside assigned territory then denied the claim
_______Intentionally violated the contract or company policy
_______Delayed your return to work by with holding medical forms or avoiding you
_______Held you off pending without good reason
_______Shows favoritism
_______Harassed you or a crew member
_______Used inappropriate or offensive language in your presence or speaking to you
_______Tried to pressure you or a crew member to hurry up and get more work done
_______Ordered you or a crew member to work where you were not qualified
_______Ordered you or a crew member to do something unsafe
_______Allowed an unsafe condition to remain after it was reported
_______Making false and conflicting statements
_______Other
Give detailed explanation:
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