Report Unsafe Staffing and Unsafe Assignments!
Welcome! Thank you for taking the first step to report an unsafe assignment or unsafe staffing at your facility. NOTE: Please only fill out this form on your break.
Before completing this form, make sure to notify your direct supervisor that your assignment is unsafe.
Please keep HIPPA guidelines in mind and do not include any identifying information about patients.
A copy of the completed form will be emailed to you, your hospital’s Human Resources Director and your 1199SEIU organizer. After completing this form, let your direct supervisor know that you have filed it and offer to print it for them if they would like a copy.