Bully Boss Documentation Form

Bully Boss Documentation Form

Submit evidence of abusive actions by supervisors, managers, and directors.
This form should only be used to submit evidence of abusive treatment or abuse of power from a supervisor, manager, or director of your employer. Please do not submit anything about a workplace lead, as they are not a part of management.

Abusive treatment towards a worker could include yelling, shouting, swearing, or saying threatening, degrading, insulting, or hurtful things. Abuses of power by a member of management could include: preferential treatment toward some workers over others; not responding to or resolving concerns; sharing an employee’s personal information; assigning work or making rules that are different than what is normally expected.

Please make a separate submission to this form for every interaction.
I understand that the information I provide could be used as evidence by the stewards, elected leaders, and/or organizer of my union, SEIU Local 49, to ensure that my employer addresses and resolves the abusive behavior and/or abuses of power committed by a bully boss.
Your name:*

First NameLast Name
Your phone number:*
Please enter a valid phone number.
Your employer:*
Email
Enter "NONE" if you do not have an email.
Email addresses will be used to send you a copy of your report, along with information on next steps and what to expect.
Date of incident:*
Estimated time of incident:*
Date of incident:

MonthDayYear
Date
Estimated time of incident:

Hour Minutes

AM/PM Option
Name of the building where incident occurred:*
Name of the bully boss:*
Have you already reported this incident to a different manager or director and given them a minimum of three (3) days to resolve your concern?*

YesNo
Why not?
Was your concern resolved?
Describe the interaction or incident between you and the bully supervisor/manager/director. Please include all relevant details: who, what, where, why, how. *
List the names of any coworkers who witnessed the incident. Provide full names if you can.*
Upload any pictures, video, audio recordings, or screenshots of text communications relate to this incident.

Cancelof
Should be Empty:

Bully Boss Documentation Form

Please make a separate submission to this form for every interaction.