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

Proudly serving over 6000 workers in Massachusetts,

Rhode Island and Maine since 1947

 

UFCW Local 791

55 Norfolk Ave

South Easton, MA, 02375

1-774-568-0791

1-800-535-2752

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