VONS Pharmacist Labor Suit Questionnaire

VONS Pharmacist Labor Suit Questionnaire

IF you were employed by VONS or SAFEWAY as a licensed pharmacist ON OR AFTER February 13, 2004, you may be a member of the plaintiff class in this lawsuit. Your colleagues and co-workers may also be members of the class - please recommend this site to them.

Your candid and honest answers to this questionnaire will help us to determine whether or not you belong to the plaintiff class and how we may reach you with any follow up questions. Within 10 days of receiving this email questionnaire, our office will contact you via email or U.S. Mail regarding the next step(s) if any.

YOUR ANSWERS NEED NOT BE EXACT BUT SHOULD BE YOUR BEST GOOD FAITH ESTIMATE OR AVERAGE. Submitting this questionnaire DOES NOT obligate you to be actively involved in ANY legal action against VONS or SAFEWAY or to provide evidence in any such lawsuit.

First Name: *
Last Name: *
Address 1:
Address 2:
City:
State:
Zip:
Daytime Phone:
Evening Phone: *
Email: *
If you are determined to be a class member, would you like your EMAIL address to be added to the Plaintiffs' Listserv for case updates? *	Yes No
During your employment with the VONS Pharmacy, were you registered as a California licensed pharmacist (R.Ph)? *	Yes No
1. Are you currently employed by the VONS Pharmacy? *	Yes No
2. Date you BEGAN work with the VONS Pharmacy: *
2(a). LAST date you worked at the VONS Pharmacy: *
3. Did you work at more than one VONS Pharmacy location? *	Yes No
3(a). Please list all VONS Pharmacy locations in which you worked: *
3(b). Please indicate the number of hours per shift you worked at each of the VONS Pharmacy stores. *
4. Were you the only pharmacist on-duty during each shift worked at the VONS Pharmacy? *	Yes No
4(a). Please provide details about your VONS work as the only pharmacist on duty, OR, any details about overlapping pharmacist coverage: *
5. Were you authorized to leave the pharmacy department for MEAL periods? *	Yes No
6. Were you authorized to leave the pharmacy department for REST breaks? *	Yes No
7. Were you able to take a 30-minute, DUTY-FREE MEAL BREAK for each 5-hour shift you worked? NOTE: "DUTY-FREE" means that you were not on duty or required to be present. "DUTY-FREE" means that you were completely free to spend that time as you saw fit (leave the pharmacy, run a personal errand, take a nap, eat, etc.), WITHOUT INTERRUPTIONS. *	Yes No
7(a). What PERCENTAGE of the time were you able to take a 30-minute, DUTY-FREE MEAL BREAK? *
8. Did you clock in and out for MEAL BREAKS? *	Yes No
9. Were you able to take a 10-minute, DUTY-FREE REST BREAK for each 4-hours of work? *	Yes No
9(a). What PERCENTAGE of the time were you able to take a 10-minute, DUTY-FREE REST BREAK? *
10. Would you be willing to sign a formal declaration regarding your experiences? *	Yes No
10(a). If you are willing to sign a formal declaration or speak with us further, please provide your preferred telephone number and the best time(s) to call (if not, enter NONE): *
11. Are there any other COMMENTS you would like to make?