Reassignment Issue Report

Reassignment Operational Issues
This form is for members to immediately report operational issues and personal impacts resulting from reassignment or schedule changes.

Your responses will be reviewed in real time and may be elevated to Department leadership, the County CEO, and the Board of Supervisors to address urgent issues.
Name (confidential)*

First NameLast Name
Mobile Phone**
Please enter a valid phone number.Format: (000) 000-0000.
Personal Email Address*
example@example.com (not your probation email)
Assignment Location*
Date of Issue*

MonthDayYear
Date
Time of Issue
What are you reporting? (check all that apply)*

Schedule / shift issueMandatory overtime / extended shiftLack of rest between shiftsReassignment impactSafety concernStaffing shortageMissed medical appointmentElder care / dependent care conflictCourt obligation conflictFatigue / exhaustionAssault or injury-related concernOther (please specify)
Please describe other issue or expand on issue above
Briefly describe what is happening (required – paragraph, limit encouraged)(What occurred? When? What shift/assignment?)
How urgent is this issue?*

Immediate (needs attention today)Urgent (within 24–48 hours)Ongoing concern
How is this affecting you personally?*

Unable to get adequate restImpacting family responsibilitiesMissed or at risk of missing medical carePhysical exhaustionMental stressSafety concernFinancial impactOther
Description of impact on you*
Briefly describe what is happening (required – paragraph, limit encouraged)(What occurred? When? What shift/assignment?)
What is the impact on your regular assignment? (if relevant)
What is not getting done? Any safety or supervision concerns?)
Do you need immediate union follow-up?*

Yes – contact me ASAPNo – reporting for documentation
Upload supporting documents (if any)

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Reassignment Operational Issues