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LU280 Check-in Form

Please Note: This form is to be filled out if you are working in LU280 Jurisdiction and NOT dispatched out of our hall.
Please see map below for more detail on LU280 Jurisdiction.

First name:
Last Name:
Email Address:
Last 4 SSN: 
Local you belong to:
Local you are dispatched out of:
Job Classification:
Phone Number:
(In case we need to contact you for more details)
Job Site:
City of Job Site:
Length of time at this site?

IBEW 280
32969 Hwy 99E, PO Box 404
Tangent, OR 97389

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