CUPE 1091 Comfort & Support Request Form
Please complete the following form for any CUPE 1091 member who is in need of comfort and support from our Union.
Date
*
-
Month
-
Day
Year
Date
Name of CUPE 1091 Member who is needing support and comfort.
*
Member's Work Location:
*
What does this member need comfort for?
*
Sick or Illness
In Sympathy: Loss of Family Member
Please list the member's sickness/illness and/or Loss of Family member below;
*
Write N/A if not applicable.
Send Flowers to this member?
*
Yes
No
Is this Confidential information only to be shared to the CUPE 1091 union?
*
Yes
No
Would this member want their sickness/illness or loss of family member to be shared publicly in the CUPE 1091 Horizons Monthly Newsletter?
*
Yes
No
Are there any other concerns that the Union needs to know to help support this member?
*
Write N/A if non applicable
Name of CUPE 1091 member who filled out this form.
*
Please email CUPE 1091 at local1091@telus.net if you have any further questions or concerns in regards to this comfort & support request form.
Submit
Should be Empty: