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Get Wa Dosh Complaints Form

Unty: Employer Phone number: Supervisor s name: Final wage rate: Have you filed a grievance? Department you worked in: Has employment been terminated? Yes No No Date: Date grievance filed: Union representative: Check related hazard type: Yes Job title: Phone number: Safety Both Health Did you request a safety or health inspection? Yes Date alleged act of discrimination occurred: No Date requested: Date you became aware of Employer s action: D.

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