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  1. PURPOSE: The purpose of this form is to notify hospital supervision that you have been given an assignment which you believe is potentially unsafe for the patients and/or staff. This form will document the situation. The union may use it to address the problem. INSTRUCTIONS: Please print clearly or use the computer to fill this form out.

  2. Objective » To educate nurses about what to do when given an assignment they believe is potentially unsafe for patients and staf. To inform nurses about how to properly fill out an ADO form. www.CalNurses.org | CalNurses | @CalNurses. ASSIGNMENT DESPITE OBJECTION. judgment is unsafe. This is usually at the start of the shift, but m.

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  3. Assignment Despite Objection (ADO) forms are admissible in court, with regulatory agencies, and are protected under federal labor law. It is illegal for management to discipline or retaliate against any nurse for filling out a form and advocating for themselves and their patients.

  4. A Nurses’ Guide to Filling Out an Assignment Despite Objection (ADO) Form. • To educate nurses about what to do when given an assignment they believe is potentially unsafe for patients and staf. • To inform nurses about how to properly fill out an ADO form.

  5. Jun 20, 2016 · Use VA Form 21-674 to inform VA that your child will remain a dependent - by reaching 18 and being still in HS, or when finishing HS and beginning a secondary educational program, or even when the child is leaving one school or type of school and entering another after 18 but prior to age 23.

  6. Do notify your CN and/or manager/supervisor on call (ADO?) for help as soon as you realize there is a problem. This may be related to patient assignment, situation or staffing levels that

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  8. Did You Know? Part 2. Assignment Despite Objection (ADO) 1 What are they? An ADO or unsafe staffing form. It’s an electronic form that nurses can use to submit complaints about assignments that they feel create unsafe situations. 2. Where are they? Scan the QR code to the left and file it online.

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