Report an Unsafe Assignment or Workplace Safety Issue Form

Your Health and Safety is AaNA’s Priority

AaNA provides you a safe place to report an unsafe assignment or workplace safety issue.

Fill out and submit the form online below. See below to submit a form offline.

    WHEN YOU SUBMIT THIS FORM, A COPY WILL BE SENT TO YOUR LOCAL UNIT OFFICERS AND AaNA. YOU WILL ALSO RECEIVE A COPY OF THIS COMPLETED FORM.

    How to Submit Your Form Offline

    If you prefer to fill, you may download a form and fill it out offline. This form should be submitted to AaNA and your local union leaders. You should also keep a copy of this completed form. Fax your form to (907) 272-0292 or send it via email to the appropriate address below:

    Providence Alaska Medical Center: prn@aknurse.org

    Central Peninsula Hospital and Heritage Place: cph@aknurse.org

    PeaceHealth Ketchikan Medical Center: ktnsecretary@aknurse.org