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 * FirstLast Phone Email Add Worker 2 Add another worker Name FirstLast Phone Email Add Worker 3 Add another worker Name FirstLast Phone Email Add Worker 3+ Add more workers More Workers info: Include name, phone, emailSummary of issue Dates of important events (be as accurate as possible) DateWhat happened? Second event Another event? DateWhat happened? More events More events? More events (include date and brief decription) Relevant individuals and how they are related to worker NameRelationship and why important Second individual? Another individual NameRelationship and why important More individuals More 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 document More documents? Description of documentUpload document Drag & Drop Files, Choose Files to Upload More documents More 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 job On probation? Yes No Unsure Work locationUnion contract? If so, which union?CityState Steward Information Name * FirstLast Intake datePhone Email *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.Previous Submit
