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Rapid Response System

Please fix the follwoing

REACT Dislocation Log

Company

Company Name:

Contact Person:

Address Line 1:

Email Address:

Address Line 2:

Phone Number:

City:

Phone Ext:

County:

Fax Number:

LWDB:

State:

Zip:

Number of Affected Employees:

Dates

WARN Notice Date:

WARN Received By State Date:

Layoff Date:

Layoff End Date:

Dislocation Reason

Dislocation Reason:

Budget cuts The act of reducing budgeted expenditures and a reduction in the profits of a business.

The act of reducing budgeted expenditures and a reduction in the profits of a business.

Did not indicate If an employer does not provide the reason for closing, they will choose this option.

If an employer does not provide the reason for closing, they will choose this option.

Reorganization The implementation of a business plan that will alter a businesses' or organizations’ structure or finances due to financial duress.

The implementation of a business plan that will alter a businesses' or organizations’ structure or finances due to financial duress.

Natural Disaster A flood, earthquake or hurricane that causes great damage.

A flood, earthquake or hurricane that causes great damage.

Loss of contract When an organization or business contract is terminated, moved or at its’ full length.

When an organization or business contract is terminated, moved or at its’ full length.

Outsourcing When goods or services are provided by a foreign supplier, due to the lack of demand, a company may have to lay off employees or permanently close.

When goods or services are provided by a foreign supplier, due to the lack of demand, a company may have to lay off employees or permanently close.

Going out of business A company, business or organization that permanently closes.

A company, business or organization that permanently closes.

Foreign Trade/Competition

When a company, business or organization transfers operations to another country.

Other

If choosen, please provide Dislocation Reason in Dislocation Comments area.

Dislocation Type:

Permanent

Temporary

Dislocation Comments:

Follow Up

Upload Document Path:

Follow Up Comments:

I hereby certify that the information provided is true and accurate.