Incident Report Form

You may either send us this form via email or print it out and mail it to Local 791.

Please fill out the form completely. Time of day, who was present, where it took place, detailed description of events, etc.

Date of Report
First Name
Last Name
Full-time (F) or Part-time (P)
Pay Rate
Date of Incident
Store Location
Steward
Manager
Witnesses
Level of Discipline
Detailed Description of Events
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United Food and Commercial Workers Union

Local 791

 

55 Norfolk Avenue

South Easton, MA 02375

 

774-568-0791

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Proudly serving workers in Massachusetts,

Rhode Island and Maine since 1947

Russell F. Regan, President
 
Frank J. Runey, Secretary-Treasurer
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