Document a Problem, Connect With Your Local

Below is a form which you can use to document workplace problems and assist your union representatives in resolving problems at the facility, including inadequate staffing and potential grievances or legal violations. We encourage you to fill in the information below and let us know more about the issues that you are concerned with. An HPAE representative will follow up and contact you.

Name (required)

Email (required)

Preferred phone number

Best time to reach you

Department

Shift

Status

Please check the issues that you are concerned about. You can check more than one issue.
Protest of assignment (unsafe/outside of job description)Do you feel like your license is at risk?Inadequate staffingUnilateral change in working conditions by managementPotential violation of state regulationsUnsafe working conditionsUnable to take breaks/mealsNot compensated for all hours workedHarrassment/bullyingADA/FMLA/EEOC issuesOther/Not sure

If you are reporting an incident, approximately when did it begin?

Additional comments or questions?