Printable Contract Violation Forms The New York Professional Nurses Union has several forms for the membership to use when a violation of the contract occurs: Staffing Documentation Form (DOC, 43k) Unsafe Assignment Documentation Form (PDF, 100k) Each of these forms is meant to help document the contract violation and protect the NYPNU Nurse. Please remember that the forms won't do anyone any good unless the right people see them. Submit any and all completed forms immediately to the Union office. Do not collect them over weeks or months at a time. And make sure you fill them out legibly. Information that is illegible might as well not exist. Remember that one of the greatest benefits of being in the Union is having a VOICE. You cannot be retaliated against because you insist on getting your break or refuse to do overtime. If a confrontation with your manager does result - it is strongly recommended that you get a union delegate to help you. When to use which form: NYPNU Staffing Documentation Form Use the NYPNU Staffing Documentation Form when you want to provide the Union with supporting documentation for an existing or potential grievance, but do not feel that it is necessary to bring the issue to management's attention immediately. This form can be used to document all contract violations, including nurse/patient ratios, as well as increased responsibilities due to higher patient acuity, lack of support staff, etc. Continue to use the standard unsafe assignment form when the situation is dangerous and you need to put management immediately on notice. REMEMBER! When you accept an unsafe assignment, you are jeopardizing the safety of your patients as well as compromising your nursing license. Unsafe Assignment Documentation Form The Unsafe Assignment Documentation form is simple and straightforward. It only takes a minute to fill out. If a manager gives you an assignment that you deem unsafe, fill out the form and give it to the manager. Strongly insist on the manager's signature, but if she adamantly refuses, note the manager's name and have a fellow nurse sign as a witness. Submit a copy to the Union office as soon as possible. If you can, call a delegate working in the hospital at the time of your unsafe assignment and get him/her involved. © 2004 New York Professional Nurses Union Ph: 212.988.5565 1104 Lexington Ave #2D New York, NY 10021 nypnu@nypnu.org Home | About NYPNU | Your Rights At Work | Political Action | Members Only | Have Fun