Abusive Supervisor Report – APWU Local 232

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Abusive Supervisor Report

Your Information

Name *

Email Address *

Phone *

Employee ID Number (EIN) *Please enter your 8-digit EIN number.

Work Location *Please enter where you work, what Tour you work on, etc.

What is your Craft? *

Abusive Supervisor's Information

Name and Title of Abusive Supervisor *Please enter the name and title of the abusive supervisor that this report is about.

Supervisor's Work Location *

Do you personally work in this supervisor's unit? *YesNo

How would you describe the work environment of the abusive supervisor's unit?Please only describe the general environment of the unit. Specific incidents can be described in detail later.

General Information

Nature of Incidents with Abusive Supervisor *Please select any of the below types of incidents you’ve experienced and/or witnessed by this abusive supervisor.Demeaning Tone/AttitudeThreatened with Discipline/Termination/Emergency PlacementSarcastic RemarksYellingProfanityPhysical GesturesPhysical ThreatsPhysical ContactSexual HarassmentRetaliationOther Threats not Listed AboveOther Harassment not Listed Above

Over the next few pages, you'll be asked for details of incidents you've witnessed. Please describe each one on a separate page.

Regarding the Worst Incident You've Witnessed and/or Experienced

Additional incidents may be provided on following pages.

Approximate Date of Worst Incident *

Approximate Time of Incident

Names of Other Witnesses

Please provide your statement of the worst incident you've witnessed and/or experienced. *

Do you wish to report another incident of abuse that you've experienced and/or witnessed with this supervisor? *

Second Incident

Approximate Date of Incident *

Approximate Time of Incident

Names of Other Witnesses

Please provide your statement of the incident you've witnessed and/or experienced. *

Do you wish to report another incident of abuse that you've experienced and/or witnessed with this supervisor? *

Third Incident

Approximate Date of Incident *

Approximate Time of Incident

Names of Other Witnesses

Please provide your statement of the incident you've witnessed and/or experienced. *

Do you wish to report another incident of abuse that you've experienced and/or witnessed with this supervisor? *

Fourth Incident

Approximate Date of Incident *

Approximate Time of Incident

Names of Other Witnesses

Please provide your statement of the incident you've witnessed and/or experienced. *

Do you wish to report another incident of abuse that you've experienced and/or witnessed with this supervisor? *

Fifth Incident

Approximate Date of Incident *

Approximate Time of Incident

Names of Other Witnesses

Please provide your statement of the incident you've witnessed and/or experienced. *

Do you wish to report another incident of abuse that you've experienced and/or witnessed with this supervisor? *

Sixth Incident

Approximate Date of Incident *

Approximate Time of Incident

Names of Other Witnesses

Please provide your statement of the incident you've witnessed and/or experienced. *

Additional Details

Please describe any other incidents and/or details you'd like to share about this abusive supervisor.

Signature

Please enter your first and last name as your electronic signature. *By entering your name, you affirm that all of the information provided in this report is true and accurate to the best of your knowledge.

Today's Date *

American Postal Workers Union
Columbus, OH Area Local 232
610 Lancaster Ave
Reynoldsburg, OH 43068

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