NURSE AND ADVANCED PRACTITIONER VIOLATION DOCUMENTATION FORM

NURSE AND ADVANCED PRACTITIONER VIOLATION DOCUMENTATION FORM

All employees have federally protected rights to form or join a union. If you believe your rights to form a union are being violated in any way -- or you just aren’t sure -- use this form to document the incident. Once you've completed the form, an organizer will reach out to discuss it and ensure your rights are protected.
For more info: Interfering with Employees Rights Section 7&8 (a) (1) Resource

National Labor Relations Board, Pittsburgh Region: 412-395-4400
Describe the incident:
Who was present at the time?
Any other witnesses to the incident?
When (date and approximate time) did it occur?
Where did it occur?
YesNo
Discriminatory enforcement of Right to TalkDiscriminatory enforcement of “Solicitation” or other policySurveillance/Spying (feeling like a supervisor is trying to listen to you talk about forming a union)Interrogation (being asked by a supervisor about the union or about who was involved)Futility (you were given the impression that even with a union nothing would change/improve)Mandatory 1:1 or Group Meeting to discuss the union
Name

First NameLast Name
Department
Phone Number
Please enter a valid phone number.
Should be Empty: