Supervisor Working Report Form
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1When Supervisors Work
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SUPERVISOR WORKING REPORT FORM
INSTRUCTIONS TO MEMBERS:
If you see a supervisor working, make note of the time the supervisor was working,
where the supervisor was working and what they were doing. Also note the names of witnesses. During break or after work complete
this form and give it to your union steward. This form must be completed off the clock, on your own time.
Name of member making report (Please print) ______________________________________________________
Your SS# _____________________________ Your Phone # _________________________________________
Your address _____________________________________ City ________________ State ____ Zip _________
Area / center you work in ______________________________ Your Sart Time_____________ AM PM
Your date of hire _________________ Your pay rate ____________ Your job title ________________________
Name of Supervisor you saw working ______________________________ Title ________________________
Date you saw this supervisor working ____________________ Name of UPS Facility ____________________
Time Sup was
Describe where the Sup was working and the
Name of a witness who
observed working.
work the Sup was doing.
saw the Sup working.
FROM _________
__________________________________________________
TO
_________
__________________________________________________ ______________________
FROM _________
__________________________________________________
TO
_________
__________________________________________________ ______________________
FROM _________
__________________________________________________
TO
_________
__________________________________________________ ______________________
FROM _________
__________________________________________________
TO
_________
__________________________________________________ ______________________
For Steward’s
Name of Steward
Grievance Number Date this form given to steward
Use Only
Supervisor working form.pub Revised Tuesday, January 31, 2012
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