Report Violations of Caregiver Safety and Contractual Rights
Instructions: You should verbally protest your assignment to your manager when you believe it is inadequate or potentially unsafe. This is usually at the beginning of the shift but may occur at any time. If your manager does not make a satisfactory adjustment to the assignment(s) at that time, complete this form to the best of your knowledge.
This form may be completed by any PECSH Caregiver. If you have questions about how to complete this form, please contact your PECSH area rep or call the PECSH office at 517.364.5111
COVID-19 Exposure Related Concerns
Direct Patient Care Related Concerns
Assignment Related Concerns