Form Lm-20 - Agreement & Activities Report

Name of person filing:

File Number: C-

9. Check the appropriate box(es) to indicate whether an object of the activities undertaken is directly or indirectly:

a.  To persuade employees to exercise or not to exercise, or persuade employees as to the manner of exercising, the right to organize and bargain

collectively through representatives of their own choosing.

b.  To supply an employer with information concerning the activities of employees or a labor organization in connection with a labor dispute involving

such employer, except information for use solely in conjunction with an administrative or arbitral proceeding or a criminal or civil judicial proceeding.

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10. Terms and conditions. (Explain in detail; see instructions. Written agreements must be attached by clicking the

Add Attachments” link at the top of the

form. If reporting a union avoidance seminar, a single copy of the registration form and a description of the seminar provided to attendees also must be

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attached by clicking the

Add Attachments” link at the top of the form.)

11. Information regarding activities performed or to be performed by the labor relations consultant pursuant to agreement or arrangement. (See instructions.)

a. Nature of activities performed or to be performed by the labor relations consultant pursuant to the agreement or arrangement:

 Training supervisors or employer

PERSUADER ACTIVITIES: Select from the

INFORMATION-SUPPLYING ACTIVITIES:

following reportable activities those which, per

representatives to conduct individual or group

Select each activity whereby you supply an

agreement with the employer(s) named in item 6,

employee meetings

employer with information concerning the

have been or will be performed:

activities of employees or a labor organization in

 Coordinating or directing the activities of

connection with a labor dispute Involving such

 Drafting, revising, or providing written materials

supervisors or employer representatives

employer:

for presentation, dissemination, or distribution

 Establishing or facilitating employee

 Supplying information obtained from:

to employees

committees

 Drafting, revising, or providing a speech for

 Research or investigation concerning

 Developing employer personnel policies or

presentation to employees

employees or labor organizations

practices

 Drafting, revising, or providing audiovisual or

 Supervisors or employer representatives

 Identifying employees for disciplinary action,

multi-media presentations for presentation,

 Employees, employee representatives, or

reward, or other targeting

dissemination, or distribution to employees

union meetings

 Conducting a seminar for supervisors or

 Drafting, revising, or providing website content

 Surveillance of employees or union

employer representatives

for employees

representatives (electronically or in person)

 Speaking with or otherwise communicating

 Planning or conducting individual employee

 Other

directly with employees.

meetings

 Other

 Planning or conducting group employee

meetings

ADDITIONAL INFORMATION:

11.c. Extent of performance:

11.b. Period during which activities performed: _______________________

mm/dd/yyyy – mm/dd/yyyy

11.d. Name and address of person(s) through whom activities were

12.a. Identify subject groups of employees:

performed or will be performed:

Name and Title ___________________________________________



Type of Person:

Employee of Consultant



Independent Contractor

Organization _____________________________________________

12.b. Identify subject labor organizations:

Street ___________________________________________________

City ____________________State ______ ZIP Code _____________

Email Address ____________________________________________

Employer Identification Number (EIN) __________________________

Form LM-20 (2016)

Page 2 of 2

Form Lm-20 - Agreement & Activities Report - 2016 Page 2

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