Environmental/Pollution Complaint Form

Help to protect our worker's health and our good jobs by reporting any potential environmental/polution issues to those who can address the problem before it becomes a real problem. ALL concerns should ALWAYS be reported to your area supervisor FIRST. If they do not respond, let us know by filling out this form and we will follow up ASAP.

ALL INFORMATION ENTERED IS KEPT CONFIDENTIAL AND IS ONLY SEEN BY UNION OFFICIALS.

First Name

Last Name

Phone Number

Enter your work phone extension. You can leave your cell phone number if you'd rather be contacted that way.

Date of Occurrence

This could be the date that the conditions were observed first or considered worsened/elevated high enough to be reported.

Approximate Time of Occurrence

Enter the name of the supervisor that was notified

Date when the supervisor was informed

This could be the date that the conditions were observed first or considered worsened/elevated high enough to be reported.

Location of Occurrence

Enter any additional information here

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