This form is to be used to report hazards, unsafe conditions, work practice and, in the opinion of the APWU, hostile work environments. You can use this form to report anything that you think could jeopardize your health: Dirty conditions, pests, mold, disturbed or broken building materials (tiles, insulation, etc.)

The form must be readily available and easily accessible to all workers on the workroom floor. You should not have to ask a supervisor for a form—they are not supposed to be locked up in a desk or stored where an employee cannot get them. The form can be submitted anonymously, but if it is you will not receive back a copy of the form that includes management’s actions to abate the problem.

If you have questions about the form, need help completing one, or can’t find one in your office, contact your local union representative.