Saturday, February 04, 2012 Current Members » Healthcare Professionals » Incident Report   Search

Healthcare Incident Report Form

This form is to be used by members to document any work-related incident that is of concern.  This is not a grievance form.  For bargaining and work safety reason, it is important for Local 341 to compile a data bank of work related incidents. 

Please be timely in reporting - should an incident be grievable, we have 7-10 days to file a Step One.

Remember - it is up to the Union to decide if an issue is a grievance or not.
Healthcare Workers Online Incident Report
Your Information
Full Name:*
Job Title:*
Employer:*
Would you LIke a Response:*


Phone Number or Email Address:
Incident Details
Date and Shift:*
Witnesses (If Any):
Shift Supervisors Name and Were They Notified:
Security Code:
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