Get Ny Ls 680 2009-2025

The NY LS 680 form is designed for individuals to file a complaint regarding mandatory overtime for nurses. This guide provides a step-by-step approach to help you complete the form online accurately and effectively.

Follow the steps to successfully complete the NY LS 680 online.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by entering your name in the designated fields (Last, First, Initial). Ensure that all information is typed clearly.
3. Input your social security number in the provided space, formatted as XXX – XX – XXXX.
4. Fill in your street address, followed by the city, state, and zip code.
5. Provide your primary telephone number along with the area code. Optionally, you may enter an alternate telephone number.
6. Specify your job title or occupation in the appropriate field.
7. Enter the name of your employer in the required field.
8. Complete the employer's street address, city, state, zip code, and telephone number.
9. Fill in the name of your supervisor.
10. If your employer's mailing address differs from the above, include that information.
11. Briefly describe the nature of your employer’s business by selecting from options such as 'Hospital', 'Nursing home', or 'Other’.
12. For each mandatory overtime incident, record the date, the hours you were originally scheduled to work, and the overtime hours you worked in the specified format.
13. Indicate whether you volunteered for the overtime by selecting 'Yes' or 'No', and provide explanations if applicable.
14. Clarify if you previously agreed to on-call shifts by answering 'Yes' or 'No', and explaining your response.
15. State whether your employer explained the reason for the mandatory overtime and detail the provided reason if applicable.
16. Determine if the overtime was due to unforeseeable emergency circumstances, explaining if necessary.
17. Indicate if you believe the overtime resulted from staffing shortages and attach any supporting documentation.
18. Answer whether the overtime requirement was due to a declared emergency or disaster, providing details if applicable.
19. Explain if the overtime was required for a patient care emergency.
20. Respond to questions regarding your employer's efforts to find additional staff, including whether they asked for volunteers or contacted other employees.
21. Note if you are represented by a union, including the local name, number, and address if applicable.
22. Provide any additional information or documentation in the designated areas and ensure all sections are completed.
23. Once all necessary fields are filled out, save changes, download, print, or share the form as needed.

Complete your NY LS 680 form online for a smoother filing experience.