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 AND
THE NJ DEPARTMENT OF HEALTH
OCCUPATIONAL SAFETY & HEALTH ADMINISTRATION
You (or your representative) have the right to file a confidential safety and health complaint and request an OSHA inspection of your workplace if you believe there is a serious hazard or if you think your employer is not following OSHA standards.