Seiu 1107-2026

1. Click ‘Get Form’ to open the SEIU 1107 assignment notification form in the editor.
2. Begin by printing your name and signing in the designated fields. If multiple individuals are objecting, utilize the reverse side for additional names.
3. Fill in your employer's name, job title, and shift/date/time details accurately to ensure proper identification of the assignment.
4. Indicate your department/unit and provide both work and home phone numbers for contact purposes.
5. Select the reasons for your objection by checking the appropriate boxes that reflect your concerns regarding safety or staffing issues.
6. In the provided space, elaborate on why you believe this assignment is unsafe. If necessary, attach an extra sheet for more detailed explanations.
7. Complete any additional information required about unit census, staffing counts, and acuity levels as specified in the form.
8. Once completed, make three copies: one for your supervisor, one for SEIU Local 1107, and keep one for your records. Ensure patient confidentiality by not identifying any patients on copies sent to the union.

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