Get Seiu Local 1107 Assignment Despite Objection Notification Form 2014-2025

This guide provides you with step-by-step instructions on filling out the SEIU Local 1107 Assignment Despite Objection Notification Form online. By following these clear instructions, you will be able to complete and submit the form effectively, ensuring your concerns are communicated appropriately.

Follow the steps to fill out the form accurately.

1. Press the ‘Get Form’ button to access the document and open it in the editing interface.
2. Begin by printing your name as the person objecting to the assignment in the designated section.
3. Sign the form in the area provided to authenticate your objection.
4. Fill in your employer's name, job title, and shift/date/time as requested.
5. Complete the department/unit information and provide both your work and home phone numbers.
6. Clearly describe the assignment you are objecting to by stating the nature of the unsafe assignment.
7. Select the reasons from the provided list that apply to your situation, such as lack of training or inadequate staffing.
8. If necessary, attach an additional sheet to elaborate on your reasoning for the objection.
9. Fill out the additional information section regarding unit census and staffing counts as accurately as possible.
10. Keep a copy for your records, submit a copy to your immediate supervisor, and send another copy to SEIU Local 1107.
11. Make sure to redact any patient identifiers to maintain confidentiality before distribution.
12. Once completed, save your changes, and choose to download, print, or share the form as needed.

Act now to file your document online and ensure your concerns are officially recorded.