Get Safe Harbor Quick Request Form - Texas Tech University - Elpaso Ttuhsc

Filling out the Safe Harbor Quick Request Form is essential for nurses who need to invoke their rights under specific circumstances. This guide provides a clear, step-by-step approach to complete the form accurately and efficiently.

Follow the steps to fill out the Safe Harbor Quick Request Form seamlessly.

1. Click ‘Get Form’ button to initiate the process and access the form in an editable format.
2. Begin by providing the names of the nurse(s) invoking Safe Harbor in the designated field. Ensure all names are spelled correctly.
3. Enter the date and time of the request. This should reflect the moment you are filling out the form.
4. Indicate the location of the requested conduct or assignment. Be specific to ensure clarity.
5. Fill in the name and title of the supervisor or person making the assignment. This is crucial for accountability.
6. Provide a brief explanation of why you are invoking Safe Harbor. Familiarize yourself with rules 217.11 and 217.12 for reference, if necessary.
7. Sign the form where indicated to validate the request. Ensure that all nurse(s) invoking Safe Harbor provide their signatures.
8. If applicable, have the supervisor sign the form as well. Note that a refusal to sign does not invalidate the nurse's request.
9. Complete any additional required section only if you intend to refuse the assignment. This may require further descriptions and collaborative input.
10. Once all sections are complete, review the form for accuracy. Save changes, and download, print, or share the form as needed.

Empower yourself with the knowledge to complete your documents online and ensure your rights are protected.