ASSIGNMENT DESPITE OBJECTION
Under NJ law, as a registered professional nurse, you are responsible and accountable for your patients.

If you are not provided with the necessary equipment and/or supplies, REPORT IT! DOCUMENT IT!
Filling out this form puts your supervisor on notice that, in your professional judgment, your work assignment is unsafe.
REMINDER: PROTECT YOUR LICENSE AT ALL TIMES!
MAKE SURE YOU HAVE MALPRACTICE INSURANCE!!
RESOURCE NUMBERS FOR PEOSH
NJ DEPARTMENT OF HEALTH PEOSH OFFICE
(609) 984-1863
NJ DEPARTMENT OF LABOR & WORKFORCE DEVELOPMENT PEOSH OFFICE
(609) 292-7036
For Union questions, please contact a Local Officer
or your Labor Rep. Victoria Pacheco:
vpacheco@jneso.org | (800) 292-0542 x128