Personal Information Information message AUPE will not disclose your information without your permission. We do not send any of your personal data to your employer without permission. If this is a working short issue and has no OHS concerns (i.e. psychological impact/physical injury), please click here to fill out the Working Short form.AUPE collects information to track and address OHS issues at your worksite. This data may be used for statistical purposes and some non-identifying information may be shared for bargaining (not your name).You may also choose to not include any personal information at all. If so, please check the box below.Submit anonymouslyBy checking this, you will not be asked to provide your name or any other personal information.Member IDFirst nameLast namePersonal emailPersonal phone number Information message If any of the information that autofilled above is incorrect, please click here to update your personal information. Information message No personal information will be shared with AUPE. Worksite InformationLocal- Select -001 - Administrative and Support Services002 - Administrative and Program Services003 - Correctional and Regulatory Services004 - Trades and Related Services005 - Natural Resources Conservation006 - Social Services009 - Health and Support Services012 - Technical and Field Services020 - Alberta Treasury Branches (ATB Financial)038 - Northern Alberta Institute of Technology (NAIT)039 - Southern Alberta Institute of Technology (SAIT)040 - Covenant ANC and GSS041 - AHS South Zone ANC042 - The Good Samaritan Society043 - AHS North Zone ANC044 - AHS Central Zone ANC045 - AHS Calgary Zone ANC046 - AHS and Covenant Edmonton Zone ANC047 - Continuing Care Separate Employers North048 - Continuing Care Separate Employers South049 - Capital Care Group050 - Alberta Gaming, Liquor and Cannabis Commission052 - University of Calgary053 - University of Lethbridge054 - AHS Edmonton Zone GSS056 - AHS North Zone GSS057 - AHS Central Zone GSS058 - AHS Southern Zone GSS060 - Alberta Innovates and InnoTech Alberta069 - Athabasca University071 - Colleges and School Divisions084 - Continuing Care Separate Employers Central/South095 - AHS Calgary Zone GSS118 - Local Government and AgenciesChapterWorksiteSector- None -Government ServicesHealth CareEducationBoards, agencies, and local governmentInclude worksite addressWorksite AddressAddressCity/TownZIP/Postal CodeIncident InformationIncident type- Select -Violence - physical/verbal/psychological or allErgonomic - lifting/strain/sprain/ - Include what body part was injuredExposure - body fluid( I.e. blood splash)/chemical (i.e cytotoxic meds)/biological (i.e. virus/fungus)Indoor Air Quality issue (i.e smoke/humity)Environmental issue (i.e. flood/severe weather) Other...Incident descriptionIncident Reporting Information message Reporting OHS concerns to the employer is a right and duty of all workers, under Section 5 of the OHS Act. Your employer cannot take disciplinary action against you for exercising your OHS rights. Section 18 of the OHS Act protects all workers, who exercise their rights under OHS. Please ensure you have reported your concern to the employer. Have you reported this issue to your supervisor/employer (i.e manager) in writing through your sites reporting system?YesNoWas it resolved to your satisfaction?- None -YesNoThank you for reporting this to AUPE OHS we collect this data to track OHS concerns with our membership.Please report this to a worker member on your JWHSC your site is covered under. The JWHSC member should be posted at your worksite. You can also contact your AUPE MSO or OHS rep at 1-800-232-7284 for assistance.Please report this OHS concern (if comfortable) through your employer’s reporting system.Would you like to speak to an OHS rep about this concern/incident?YesNo Information message If you have been injured at work in any capacity you have the right to file a WCB claim through wcb.ab.ca. You have two years from date of injury to report. I would like to receive a copy of this formSend copy to this email addressThis form is sent to the AUPE occupational health and safety (OH&S) department for review. After review, they will respond to you if you requested them too and will forward this information to your assigned AUPE Membership Services Officer (MSO) so they are aware of the work site concern. AUPE does not send this information to your employer on your behalf.Your personal information is collected under the authority of the Freedom of Information and Protection of Privacy Act (FOIP) and the Personal Information Protection Act (PIPA). If you have any questions about the collection of your personal information please call the Member Resource Centre at 1-800-232-7284 or 780-930-3300 and ask to speak to the Privacy Officer.
