Stewarding Intake Form Stewarding Intake Form Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form. - Step 1 of 2 Affected Worker(s) Info Name *FirstLastPhoneEmailAdd Worker 2Add another workerNameFirstLastPhoneEmailAdd Worker 3Add another workerNameFirstLastPhoneEmailAdd Worker 3+Add more workersMore Workers info: Include name, phone, emailSummary of issue Dates of important events (be as accurate as possible) DateWhat happened?Second eventAnother event?DateWhat happened?More eventsMore events?More events (include date and brief decription) Relevant individuals and how they are related to worker NameRelationship and why importantSecond individual?Another individualNameRelationship and why importantMore individualsMore individuals?List additional relevant individuals with relationship and why they are importantWho else knows about issue? What do they think?How do other societal issues such as sex, race, sexual preference, or environment (heat, allergies, storms, health impact) play a role? List and upload the relevant document(s) Description of documentUpload document Drag & Drop Files, Choose Files to Upload Another documentMore documents?Description of documentUpload document Drag & Drop Files, Choose Files to Upload More documentsMore documents?List additional documents and get copies of them.What resolution does the worker seek?Union contract or policies that were violated? Additional worker and workplace information EmployerWhat industry/kind of workYears working at jobOn probation?YesNoUnsureWork locationUnion contract? If so, which union?CityState 3+ issues name, Steward Information Name *FirstLastIntake datePhoneEmail *Follow up plan and actionsNextUpdating preview…This is a preview of your submission. It has not been submitted yet! Please take a moment to verify your information. You can also go back to make changes.PreviousSubmit
