Email address (your information is never shared or sold) *
Your answer
Phone number (your information is never shared or sold) *
Your answer
Mailing Address (to determine what members of Congress serve your area) *
Your answer
What kind of health care facility do you work in? *
Your answer
What is your job title? *
Your answer
How long have you worked in health care? *
Your answer
Share your story of workplace violence: *
Be descriptive. Things to consider while answering this question: What was staffing like? Were you alone? What were your injuries? Did you require medical attention? Did you have to take time off? Was your perpetrator prosecuted? How could legislation that holds employers accountable for workplace violence have helped in your situation? Do not limit your answers to incidents with patients only - share your experience that occurred at work no matter the parties involved.
Your answer
Tell us about your employer:
Things to consider when answering: Does your employer have a policy, protocol, or other controls, in place to address workplace violence? How did your employer respond? Were you disciplined by your employer?
Your answer
Tell us about your union:
Things to consider when answering: Was your union notified when this incident occurred? How was your union able to help? What do you wish your union could do in your situation? What tools does your union need to hold your employer accountable when you're injured through workplace violence? Do you have contract language that addresses workplace violence?
Your answer
Will you authorize the United Steelworkers share your story with lawmakers and in our publications? *
Would you be willing to share your story through public testimony? *