Worksite Meeting
Worksite: __________________________________________________________
Topic:_____________________________________________________________
Guest Speaker:______________________________________________________
Print Name
Signature
Date:______________ Time:________________ Place:_________________
Employees attending meeting:
(If additional room is needed please sign on back)
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Bldg. Reps, Alt. Reps and Exec. Brd. Mbrs. sponsoring and attending the meeting:
____________________ ____________________
BR
Alt. Rep.
Exec. Brd.
Print Name
Signature
__________________ __________________
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Alt. Rep.
Exec. Brd.
Print Name
Signature
__________________ __________________
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Alt. Rep.
Exec. Brd.
Print Name
Signature
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Alt. Rep.
Exec. Brd.
Print Name
Signature
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Alt. Rep.
Exec. Brd.
Print Name
Signature
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Alt. Rep.
Exec. Brd.
Print Name
Signature
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Alt. Rep.
Exec. Brd.
Print Name
Signature
Important Reminders:
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Retain a copy of this form for your records.
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Send this form (original) to the USEP office within 2 weeks of meeting date.
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Be sure USEP President or staff, AIG Valic, Liberty Mutual or California Casualty representatives have signed in.