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

United Food and Commercial Workers Union

Local 791

 

55 Norfolk Avenue

South Easton, MA 02375

 

774-568-0791

Proudly serving workers in Massachusetts,

Rhode Island and Maine since 1947

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