Reimbursement and Supply Change Survey for Local 5058

Your Name (required)

Your Department (required)

Your Cell Phone Number

Your Email (required)

Reimbursement Issues

Are you having an issue getting reimbursed for a certification or conference? (required)
YesNo

Please provide more information about your experience including name, date of the event and if you have brought this to your manager. What steps did you take?

Supply and Materials Issues

Have you seen a change in materials in your work area? (for example the brand of syringe used) (required)
YesNo

Provide more information here - Include the name of the previous brand used and the current as well as how you use this material and the approximate date of the change.

What if any is the effect on your work related to patient care or effective usefulness of the material by the change of brand/ material? For example, when we use the new brand of diapers the patients are showing increased cases of diaper rash.