| Worksite/Unit: | |
| Job Title: | |
| FTE: | |
| Years Employed: | |
| Shift Rotation: | |
| Check if payroll accuracy needs improvement: | |
| Check if shift differentials need improvement : | |
| Check if anniversary steps/the wage grid needs improvement: | |
| Check if benefits for long-tem staff need improvement : | |
| Check if paid time off needs improvement : | |
| Check if weekend differential needs improvement: | |
| Check if tuition reimbursement needs improvement : | |
| Check if charge pay needs improvement : | |
| Check if health insurance needs improvement : | |
| Check if we should be able to pyramid OT for call-in shifts: | |
| What Economic issue not listed above is important to you?: | |
| Check if transfer/promotion process needs improvement : | |
| Check if staffing levels need improvement : | |
| Check if job posting process needs improvement: | |
| Check if scheduling time off needs improvement: | |
| Check if discipline process needs improvement: | |
| Check if on-call scheduling needs improvement: | |
| Check if regular work scheduling needs improvement: | |
| Check if per diem scheduling needs improvement: | |
| Check if orientation to units needs improvement: | |
| Check if comp. time needs improvement: | |
| Check if weekend scheduling options need improvement: | |
| Check if sick leave rules need improvement: | |
| Check if orientation to new equipment needs improvement: | |
| What Non-Economic Issue not listed is important to you?: | |
| What is most important to you?: | |
| Pick the THREE top reasons for staff dissatisfaction: | |
| Other: | |
| What is the most positive aspect of working for UWHC?: | |
| What is the most negative aspect of working at UWHC?: | |
| What is the most important thing to win in bargaining?: | |
| What will you do to help us be successful?: | |
| Name: | |
| Home Phone: | |
| Personal email address: | |
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