Thank you for submitting a Patient Safety Reporting Form.

Please check your email for a confirmation message, with a link to print your signed report. If you do not receive the email, please contact your Union Rep/Organizer.

By filing this form, you are complying with the law, protecting your hard-earned license, showing solidarity with your co-workers, and most of all, advocating for your patients!

If this is an urgent matter, please also contact your Union Rep/Organizer—you can find their contact info here.