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Welfare Support Questionnaire
First name
*
Last name
*
Birthday
*
Day
Month
Year
Email
*
Phone
*
Workplace name and address:
*
Payroll number
*
Job title:
*
Employer or contractor name:
*
How long have you been working there?
*
Do you have an employment contract?
*
Please explain briefly why you are requesting welfare support.
*
Are you currently unwell, injured, or experiencing any medical issues?
*
Do you have any disability or long-term condition that affects your work or daily life?
*
Have you provided medical evidence (e.g., doctor’s note, fit note)?
*
Are you currently receiving Statutory Sick Pay (SSP) or any other benefits?
*
Have you had any welfare meetings or reviews with your employer?
*
What outcome or support are you seeking from CAIWU?
*
Do you need assistance with workplace adjustments or other issues?
*
Is there anything else you would like to add or that we should know about your situation?
*
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