WV Public Employee OSHA Survey
Please fill out any part or all of this survey and return it to the WV Public Workers Union Hall or email your responses to our email address on this flier (Please use another sheet if necessary).

1) Is your work place always safe? Y / N

2) Do you feel that your health or safety is in jeopardy at work? Y / N

3) Describe your safety or health concern?

4) Is the safety hazard ongoing, frequent or occasional?

5) Are you concerned that you might be working in a sick building? Y / N

6) Are you (or your co-workers) experiencing sick-building symptoms (these may include respiratory problems, chronic illness, headaches or nausea), which may be caused by mold, lack of ventilation, maintenance or other chemical odor and indoor air quality issues?

7) Have you reported your health or safety concerns to an authority? Y / N

8) If yes, who did you report your concerns to, when and what was the result?

If you want more information about the public workers union or about representation regarding problems with your building or how to file an OSHA complaint, please send your name and contact information to the union today.

Your Name ____________________________________ Work location__________________________________
Address____________________________________________
City __________________ State _____ Zip code ___________
Phone # _____________________

Send your survey responses to:
West Virginia Public Workers Union, UE Local 170
1591 Washington St. E.,
Charleston, WV 25311
Call (304) 699-4401 - or email - uelocal170_info (at) yahoo.com