CAPS-UAW Workplace Issue Reporting Form
We, the workers must actively enforce our rights and our union contract in our workplace to implement and maintain the gains won! Please fill out this form if you think you are experiencing violations of your rights – a peer union representative will follow up with you about potential next steps.
Name
*
First Name
Last Name
Where do you work?
Please Select
CARB - Air Resources Board
BCDC - SF Bay Con&Dev Cm
BHSOAC - Mental Hth Svs Overs
BSCC - State & Community Corrections
CA Tahoe Conservancy
CalEPA - Secretary's Office
CalFire - Forestry And Fire Protection
CalGuard - Military
CalOES - Emergency Services
CalRecycle - Resources Recycle/Recvry
Caltrans
CCC - CA Coastal Commission
CCFC - CA Children/Families 1st Com
CCHCS - Corr. Hlth Srvc.
CDCR - Corr. and Rehab.
CDE - Education
CDFA - Food And Agriculture
CDFW - Fish And Wildlife
CDPH - Public Health
CDPR - Parks And Recreation
CDPR - Pesticide Regulation
CEA - Earthquake Authority
CHHS - Office of the Secretary
CHP - Highway Patrol
CNRA - Natural Resources
Colorado River Board
Covered California - Health Benefit Exchange
DCA - Consumer Affairs
DCC - Cannabis Control
DDS - Developmental Services
Delta Conservancy - Sacto-San Joaquin
Delta Protection Commission
Delta Stewardship Council
Dept. of Conservation
DGS - General Services
DHCS - Health Care Services
DIR - Industrial Relations
DOJ - Justice
DSH - State Hospitals
DTSC - Toxic Sub. Control
DWR - Water Resources
Energy Research and Development Division
HCAI - Health Care Access And Info
High Speed Rail Authority
OEHHA - Envirnmtl Hlth Hazrd Assess
OEIS - Energy Infra Safety
PERB
SDRC - San Diego River Conservancy
Sierra Nevada Conservancy
State Lands Commission
WCB - Wildlife Conservation
SWRCB - State Water Resources Control Board
Other
Personal Phone
*
Please enter a valid phone number.
Format: (000) 000-0000.
Personal Email
*
example@example.com
Work Email
*
example@example.ca.gov
City of your workplace reporting location
*
Your union district
*
Please Select
District 1
District 2
District 3
District 4
District 5
District 6
District 7
District 8
I don't know
I'm a member of the public or media
Not sure what union district you are part of?
Click here
to look up your district.
Work Address
*
I am a
*
Please Select
Rank-and-file Scientist
Supervisory Scientist
Managerial Scientist
None of these
Please select the area in which you may be experiencing violations of your rights
*
Please Select
Wages (e.g. incorrect payment, non-payment, incorrect range placement)
Abusive conduct/bullying, harassment, discrimination
Health and safety issues
Access needs (e.g. workers with disabilities being denied an appropriate accommodation)
Parent Rights (e.g. difficulties accessing paid parental leave)
Workload
Other
Please provide a brief description of the issue you are experiencing:
*
Briefly describe your issue in 150 or fewer words.
0/150
Do you have a photograph(s) to submit of the unhealthy work conditions?
*
Yes
No
Submit a photos of an unsanitary, unsafe or dysfunctional part of your worksite.
*
Browse Files
Drag and drop files here
Choose a file
Ideal photographs show detail of the problem, a photo of context a few feet away, and a photo of further back to allow viewing the surrounding space.
Cancel
of
When was the photo taken?
*
-
Month
-
Day
Year
Date
Photo description
*
Have you talked to your supervisor, facilities manager, or otherwise reported this issue?
*
Yes
No
No, but they are aware of this issue
Has action been taken to remedy the situation?
*
Yes
No
If yes please describe
I want to help make my Union stronger! Contact me about getting involved.
Yes
Submit
Should be Empty: