Notice of Risk

Notice of Risk to Patient Care

The members of SEIU Healthcare Wisconsin are dedicated to providing patients the best possible care. If you are working in conditions that interfere with providing the best possible care to patients, please complete a Notice of Risk to Patient Care Form. Use the form to report assignments which you are directed to accept despite your objection and/or at any time which you feel patient safety is compromised.

  • Please be sure to make a copy of the completed Notice of Risk to Patient Care Form before sending to managers. Forward a completed copied form to the SEIU HCWI office  as well; together we can help make sure members are working together to fix the unsafe condition.
  • Do not identify any patient by name on this form.

Select A Form For Your Workplace:

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