1. What new agenda items did you discuss with the Union
       members of the Joint Health & Safety Committee for this
       month's meeting?
       __________________________________________________
  
       2. What items did you report to the local membership at
       the last monthly Union meeting?
       __________________________________________________
 
       3. Have you attended any training this month?
       __________________________________________________
 
       What topic?
       __________________________________________________
 
       Presented by whom?
       __________________________________________________
 
       4. What was the most important project you worked on this
       month?
       __________________________________________________
 
       5. What was your biggest success?
       __________________________________________________
 
       6. Have there been any serious incidents or near-misses
       at your facility since your last report?  Yes  No
 
       Please describe:
       __________________________________________________
 
       Were you involved in the investigation?  Yes  No
 
       7. Do you need information or any H&S topics that the
       International can provide (chemical safety info, OSHA
       interpretations, H&S contract language)?
       __________________________________________________
 
       8.  Describe lessons learned from an incident in your
       facility that could prove helpful to other H&S Reps:
       __________________________________________________
 
       cc: Local Union President
           Union Chair, H & S Committee