Workplace Violence Prevention

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* 1. Name (First and Last)

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* 2. Which hospital do you work at?

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* 3. Mobile Number*

* By providing my mobile phone number, I understand that SEIU and its locals and affiliates may use automated calling technologies and/or text message me on my mobile phone on a periodic basis. SEIU will never charge for text message alerts. Carrier message and data rates may apply to such alerts. Text STOP to 787753 to stop receiving messages. Text HELP to 787753 for more information.

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* 4. Please check all that apply. To my knowledge, management at my hospital has not yet:

Completed a comprehensive hazard assessment for each unit and each shift

Worked with RNs and our Union to develop a prevention plan

Involved RNs to evaluate the plan once it is developed

Developed training on the prevention plan with RNs and our Union

Trained all staff on the plan and how to implement its safety requirements

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* 5. I’m interested in working with other RNs at my hospital to protect us against workplace violence!

Yes