Workplace Issue Screening Form | Union of Northern Workers

The information you provide in this form is confidential and will only be used by the Union of Northern Workers to assess how best to assist you to resolve a workplace issue. The information submitted on this form will not be provided to or discussed with your employer without your express permission.

Submitting this form does NOT mean you have filed a grievance. You will be contacted by a union representative to discuss your situation and next steps.

If you have any questions about this form or would like to speak directly to a UNW Service Officer, contact the UNW Service Administrative Assistant.

Full Name

First

Last

Email Address

Phone Number

Is it okay to leave you a voicemail?

Yes

Employer

Please select your employer from the drop down menu

Department

Tell us about your issue

Please provide us with as much detail as possible. For example: type of issue, important times and dates, any upcoming meetings with your supervisor, applicable section of collective agreement, etc.

Math question

5 + 5 =

Solve this simple math problem and enter the result. E.g. for 1+3, enter 4.