CWA Local 6210 | Statement of Occurrence

Statement of Occurrence

All fields are required unless otherwise noted

Name:

Work Location:

Address:

Job Title:

Home Phone:

Work Phone:

Email:

Supervisor Name:

Supervisor Phone:

NCS Date:

Date Event Occurred:

Article Violation:

Description of Event: 0 / 2000

Proposed Remedy: 0 / 725

Additional Information (Optional): 0 / 590

Signature:

Sign above

I hereby give consent to the inspection by any authorized Union Representative of any records kept by the Company which may affect the conditions of my employment, which may include Security Reports, Medical Records or Opinions, Police Reports, Court Records or Reports, or any other information which may be relevant and necessary to allow the Union to protect my rights under the Working Agreement between the Union and the Company. This authorization is given in accordance with the existing agreement between the Union and the Company.