AFSCME DISTRICT COUNCIL 33
Unsafe Working Conditions Survey

Please tell us about your unsafe workplace conditions.

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* 1. Please enter your full name.

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* 2. Please enter your personal e-mail address.

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* 3. Please enter your telephone number.

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* 4. Select your employer.

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* 5. Enter your work location.

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* 6. Enter your job title.

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* 7. Enter the description of your issue.

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* 8. Please upload a photograph of the unsafe condition if applicable.

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.