UFCW Local 1000 Coronavirus Survey
Tell us what's going on so we can help!
Sign in to Google to save your progress. Learn more
Email *
First Name
Last Name
Cell Phone
Check any health and safety supplies or protective gear that is MISSING from your workplace. *
Employer *
Store Number (if necessary, write none if store doesn't apply) *
Is your employer conducting temperature checks on employees at the start of their shift? *
Is your employer enforcing social distancing guidelines at work? *
Is your employer limiting the number of customers or employees in the store/facility? *
Are you trying to utilize your company's paid sick leave and having issues? Detail the problems.
Clear selection
What other safety concerns do you have in the workplace?
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy