Form F-7 Form F-7 Notice to Mediation Agencies

FMCS FORM F-7
NOTICE TO MEDIATION AGENCIES
Revised January 2003
You may file this form electronically at www.fmcs.gov

Form Approved
OMB NO. 3076-0004
Expires 12-31-2010

MAIL TO:
TO YOUR STATE OR TERRITORIAL MEDIATION AGENCY:
NOTICE PROCESSING UNIT
FEDERAL MEDIATION AND CONCILIATION SERVICE
2100 K STREET, N.W.
AND
WASHINGTON, DC 20427
You are hereby notified that written notice of proposed termination or modification of the existing collective bargaining contract was served upon
the other party to this contract and that no agreement has been reached.

Type of Notice:

¨ Existing Cont ract

1. IF THIS IS A HEALTHCARE INDUSTRY NOTICE:
PLEASE INDICATE (MARK “X”)

¨ Initial Contract
2. Mark “X” AND DATE(S):
¨ CONTRACT REOPENER
To be filled in only if existing
contract provides for reopening
for specific c hanges during its
term or if voluntary reopener

¨ INITIAL CONTRACT
¨ EXISTING CONTRACT

¨ CONTRACT EXPIRATION

¨ Grievance

REOPEN DATE

(Month/Day/Year) ___/___/____

EXPIRATION DATE (Month/Day/Year) ___/___/____

EXPIRATION DATE (Month/Day/Year) __/___/_____

3. NAME OF EMPLOYER NAME/ASSOCIATION/ORGANIZATION (IF MORE THAN ONE, ATTACH A LIST OF NAMES AND ADDRESSES.)
EMPLOYER NAME:__________________________________________________________________________________________________________________________

4. Street Address:____________________________________________________________________________________________________________________________

City:_________________________________________________________________________State: ____________________________________Zip Code: ____________

5. Name of Employer Representative: _______________________________________________________________________ Title: ________________________________

6. Phone: (

)_____________________________Fax: (

) ____________________________E-mail Address: ____________________________________

7. NAME OF INTERNATIONAL UNION OR PARENT BODY_______________________________________________________________________________________
8. UNION NAME:_________________________________________________ DISTRICT # __________ COUNCIL # __________
9.

LOCAL/LODGE #_____________ ___

LU Street Address: ______________________________________________City: ___________________________________State: ___________ Zip Code: __________

10. LU Official to Contact: _______________________________ ______________________________________ Title: ___________________________________________

11. Phone: (

)_____________________________Fax: (

)________________________

E-mail Address: ______________________________________

12A. LOCATION OF AFFECTED ESTABLISHMENT-CITY:______________________________________________STATE: ________ZIP CODE:______________
12B. LOCATION OF NEGOTIATIONS (IF DIFFERENT FROM 12A) CITY:__________________________________ STATE:________ ZIP CODE:____________
13. NO. OF EMPLOYEES COVERED BY THIS CONTRACT

14. TOTAL NO. EMPLOYED AT AFFECTED LOCATION(S)

15. INDUSTRY AND/OR TYPE OF BUSINESS

16. PRINCIPAL PRODUCT OR SERVICE

17. THIS NOTICE IS FILED ON BEHALF OF THE: (MARK “X”)
¨
UNION
¨ EMPLOYER
__________________________________________________________________________________________________________________________________________
18. TYPE OF NEGOTIATIONS (MARK “X”)

19. TYPE OF EMPLOYEES COVERED (MARK “X”) FOR ALL THAT APPLY

¨ SINGLE ESTABLISHMENT

¨ MULTI-PLANT

¨ PROFESSIONAL/TECHNICAL

¨ CLERICAL

¨ AREA OR INDUSTRY WIDE

¨ MULTI-EMPLOYER

¨ PRODUCTION/MAINTENANCE

¨ CONSTRUCTION

¨ OTHER (SPECIFY)
¨ OTHER (SPECIFY)
__________________________________________________________________________________________________________________________________________
20. NAME AND TITLE OF OFFICIAL FILING NOTICE
21. SIGNATURE AND DATE
__________________________________________________________________________________________________________________________________________
PAPERWORK REDUCTION ACT NOTICE: The estimated burden associated with this collection of information is 30 minutes per respondent. Comments concerning
the accuracy of this burden estimate and suggestions for reducing this burden should be sent to the Office of General Counsel, Federal Mediation and Conciliation Service,
2100 K Street, NW, Washington, DC 20427 or the Paperwork Reduction Project 3076-0003, Office of Management and Budget, Washington, DC 20503.

INSTRUCTIONS FOR COMPLETING THE FORM F-7
Mail all F-7 Forms to the Federal Mediation and Conciliation Service, Notice Processing Unit, 2100 K
Street, NW, Washington, DC 20427. Do not send copies to any other FMCS Office. You must forward a

copy of this form to your State or Territorial Mediation Agency, if appropriate. FMCS will not forward
copies to these agencies. Receipt of this form does not constitute a request for mediation nor does it

commit FMCS to offer its facilities. Receipt of this notice will not be acknowledged in writing by FMCS.
Use of this form is voluntary and will facilitate our service to respondents. Maintain a copy for your
files.

Line 1:
Line 2:
Line 3:

Please check only if the employer provides HEALTH CARE SERVICES.
Provide CONTRACT EXPIRATION DATE. If Notice is submitted for a CONTRACT REOPENER,
provide both dates. Check the appropriate box for which you are submitting this form.
Give complete name of employer. Spell out the full name. Do not use abbreviations. If the employer has only
abbreviations in its name, please write “abbreviations only” after the name.

Line 4:
Lines 5/6:

Provide a complete address for the employer, including room and suite numbers.
Provide the name of the official who represents the employer, including the phone and fax numbers and e-mail
address.

Line 7:

Provide the name of the International Union or Parent Body. If an independent union, provide full name even
if Line 8 is repeated.
For unions identified on Line 7, please use the appropriate numbers for the union’s DISTRICT, COUNCIL,
and/or LOCAL/LODGE.
Provide complete addresses, including room numbers. Please include e-mail addresses, if available.
If the company is the same location as the address on Line 4, put “SAME AS ABOVE”; if different, please
provide where the negotiations will most likely occur. Do not include the hotel, motel or meeting room. Give
only the city, state and zip code.
The numbers contained in Lines 13 and 14 are rarely the same. There are usually supervisors, clerical, sales or
other employees at the same location who: 1) are not union members; 2) are members of other unions; or 3)
may be members of this union but covered under another contract.
13: If you are unable to estimate the total number employed at the affected locations (union and non union
combined, please leave blank rather than duplicating the information provided in Line 14.
Please provide information on the industry of the employer listed on line 3. (You may use the industry listing
below.) Do not provide information on what the bargaining unit does.

Line 8:
Lines9/10 & 11:
Line 12.

Lines 13/14:

Line 15:
Line 16:
Line 17:

Please provide information on what product or service the employer on Line 3 provides. Again, do not provide
information on what the bargaining unit does.
Please indicate whether the employer or the union is filing this notice.

Lines 18/19:
Lines 20/21:

Please check the block that is most appropriate.
Self-Explanatory.

INDUSTRY LISTING
A= Mining, Coal
B= Mining, Other
C =Construction
D =Petro Chemicals
E = Manufacturing
F = Transportation
G =Communications
H =Electricity/Natural Gas
J = Retail/Wholesale/Service

K = Maritime
L = Healthcare
P = Federal Government
Q = State Government
R = Local Government
S = Other
T = Food Manufacturing/Processing
U = Food Retail Sales/Distribution
X = Unknown