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Safety Committee Members Reporting Form
Fill this form out to share with us the name and contact info of the members on the committee.
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* Indicates required question
Name of person submitting this form: Last name, First name
*
Your answer
Name of CTU member #1: Last name, First name
Your answer
Email for CTU member #1
Your answer
Name of CTU member #2: Last name, First name
Your answer
Email for CTU member #2:
Your answer
Name of CTU member #3: Last name, First name
Your answer
Email for CTU member #3:
Your answer
Name of CTU member #4: Last name, First name
Your answer
Email for CTU member #4:
Your answer
Building engineer: last name, first name
Your answer
Building engineer email:
Your answer
Other member: Last name, first name
Your answer
Which union is the committee member from?
Other
SEIU Local 73
SEIU Local 1
HERE
Other
Other
SEIU Local 73
SEIU Local 1
HERE
Other
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Email for member:
Your answer
Other comments or members in the committee? Please add full name, union and email address.
Your answer
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