Millwrights Weekly Shop Steward Report

Millwrights Local 1163
Millwrights Weekly Shop Steward Report
6489 Riding Road Syracuse, NY 13206 Phone (315) 671-0672 Email: local1163@nasrcc.org
Employers Name*
Employers Phone Number
Job Name*
Forman Name*
Job Address
Week Starts (Mondays Date)*

MonthDayYear
Date
Shift*

Members Names and Hours

	Name Of Member	Member ID	Local	Mon Hours	Tues Hours	Wed Hours	Thurs Hours	Fri Hours	Sat Hours	Sun Hours	Total Hours
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2
3
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SHOP STEWARD*
Name
SHOP STEWARD LOCAL NO*
SHOP STEWARD EMAIL*
example@example.com
SHOP STEWARD TELEPHONE NO.*
Remarks
Council Repesentative*
Rep who is dealing with Job
Employer Verification:
I Verify That The Above Informantion is Correct

Clear
SIGNATURE
DATE

MonthDayYear
Date
Should be Empty: