ASSIGNMENT DESPITE OBJECTION
Under NJ law, as a 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!!
NEW JERSEY DEPARTMENT OF HEALTH
COMPLAINT HOTLINE: (800) 792-9770
For Union questions or concerns, please contact your
Labor Representative Meredith Larson:
[email protected] or (732) 745-2776 x115