INDUSTRIAL COMMISSION OF ARIZONA Labor Department 800 W WASHINGTON STREET PHOENIX, ARIZONA 85007 (602) 542-4661 Public Complaint Referral Form O Youth Labor Complaint © Labor Law Complaint Submit Date: 11/19/2018 EMPLOYER INFORMATION Identify the employer you are issuing the complaint against. Employer business name COrizon Healthcare Eyman state prison complex Address 4374 E. butte Ave city Florence sue AZ zip 85132 Phone 4808256083 ‘Type erbusiness health care Jowner's name & utle COrizon ERC Leo ae ee Re Sc Youth's approximate age Youth's name, if known Date of incident ‘Location of incidemt Describe what you observed Pe ee ‘This complaint involves: [Nor recsiving pay stub with pay check, [Z] Employer not paying on presribed paydays Csr check [1] Pay card issue Other (deseribe) ‘There is no nurse to patient ratio due to being short staffed for over a year. Were not able to take any brakes, Inadequate training for emergency situations, inadequate nursing care. Medication lerrors due to being short staffed. Management notified with no resolution. unsanitary work ‘environment, DMPLAINANT INFORMATI Name Siento goatee Address Civy State Zip Cell Phone Email address f I wish to remain anonymous [¥] Phone Labor ICA 3304-Rev 10.15.17