United Transportation Union
Indiana Legislative Board
Local____________
Safety Complaint Form
To:________________________________ Date:_______________________
Attention:___________________________
At our monthly union meeting, our members reported that the following unsafe condition
exists:
Item:___________________________________________________________________
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Location:_______________________________________________________________
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______________________________________________________________________
Complaint:______________________________________________________________
______________________________________________________________________
______________________________________________________________________
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We hereby request that this unsafe situation be corrected and that I be advised when
completed.
____________________________
Legislative Representative
Reported to FRA Yes____________ No_____________, Awaiting RR
Reply__________
File #________________________________