Burlington System Division
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    2022 National Division Convention

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    Upcoming Events
    Lodge 1108 Meeting
    Jul 14, 2022
     Alliance, NE (CLC Bldg)
    Lodge 800 Meeting
    Jul 20, 2022
     Paul and Jack's Tavern 1808 Clay St. North Kansas City, MO 64116
    Lodge 1142 Meeting
    Aug 06, 2022
     First State Bank, Guernsey, WY
    Lodge 509 Meeting & Annual Picnic
    Aug 13, 2022
     Stoddard Park Stoddard, WI
    Lodge 1533 Meeting
    Aug 18, 2022
     Machinist's Hall IAMAW Local 1010 16452 US-34 BUS West Burlington, IA (Middletown)
  • Witness Statement Online
    Sample form below. You can edit this form and edit this text. The text will show up at the top of the form page, just as you see it now. You can edit the form using the buttons above.
     
    First name:
    Last Name:
    Email Address:
    Employee Number:
    Position at Time of Statement:
    Is this regarding a Claim? YES                NO
    If YES, what Claim?

    Location of Witnessed or Discovered 

    Work or Violation

    Detailed Description of what you Witnessed

    What was done?

    Who was there?

    When did it happen, and for how long?

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