Have you ever experienced work conditions that you believe caused you undue stress, might be unhealthy or made you sick? Please share your story with us.

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If you would like to submit a true account of your work experiences ("your story") below, please first read our Healthy Work Campaign Share Your Story Terms & Conditions.

By submitting this form, you consent to our using your story, in full or in part, on our Healthy Work Campaign website, healthywork.org, in our promotion of our website on our social media channels, and anonymously in our "Healthy Work Now" articles on Medium.com.

Also, if you are interested in being interviewed (see below), we will ask you to sign a release form giving your approval to use your story in our documentary.

We will never share your personal information, with the exception of your first name and state of residence, should you choose to provide those.

We will only send information related to "Working on Empty" as you consent to per the settings below.

Last Name, First Name (e.g.: Doe, Jane)

State (within the U.S.)

Zipcode

Have you ever had an experience at work that you would describe as “stressful” or “toxic” or that may have negatively affected your health and well-being? Write a paragraph about your (true-to-life) work-related experiences. (If someone you know has relevant experiences, please share our website and ask them to fill out the "Share Your Story" form themselves.)

Do you have a photo related to your work story you would like to share? (If so, we will follow-up with you. We ask that you please not submit images containing nudity, violence or other content inappropriate for children and youth.)

Yes

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Would you be willing to be interviewed further via email or over the phone?

Yes

Would you be willing to be interviewed on camera for our multi-media documentary?

Yes

Are you interested in participating further in our multi-media documentary by following us on social media and/or donating?

Yes.

Would you like to subscribe to our newsletter?

Yes

Do you consent to your story being published on the Healthy Work Campaign website?

Yes

Other:

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Visit WorkingonEmpty.org & HealthyWork.org for more info.

Submit

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