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Complaint Form
Local 617/ Laundry, Distribution and Food service Joint Board, Workers United, SEIU
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First Name
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Last Name
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Home Address
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City
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Zip
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Phone Number
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Email
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Employer
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Union Representative
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Martha Rodriguez
Larry Howell
Lorenzo Hall
Stanford Dempster
Date of Incident
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DD
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YYYY
Name of Witness (es)
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Type of Incident
Unfair Discipline
Contract Violation
Health and Safety
Other
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Briefly Explain the Problem
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Acknowledgement
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I understand that this complaint will be investigated by the union. A union representative will contact you by email, phone and/or text.
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