Township Employee Concern Report Form

Township Employee Concern Report Form

Submit evidence of abusive actions by supervisors, managers, and directors.
Please make a separate submission to this form for each separate concern or problem that you need to report. A copy of your report will be sent to SEIU Local 49 Union Organizer, Jillian Johnsen, and to Township Operations Director, Justin Galias.
VANID
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.Format: (000) 000-0000.
Your employer:*
Personal 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:*
Name of the building where incident occurred:*
Name of your manager:*
YesNo
Why not?
Was your concern resolved?
Describe the interaction, problem, or incident that you would like resolved. Please include all relevant details including 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.

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