Concern For Safe Staffing Form


  1. Prior to using this form, you must notify the ANC/manager in person or by phone of your need for more help. This form is to document your request. If you didn’t make the request, you can’t use it.
  2. Use this form only if you don’t have adequate help. If these forms are used indiscriminately and without justification, it will dilute their usefulness.
  3. The completed form will be submitted to your unit manager and VFNHP.

CFSS Forms serve as a means to:

  • Provide your supervisor an opportunity to correct an unsafe situation
  • Limit your personal and professional liability
  • Document trends in staffing, patient volume and/or acuity levels for your Unit Staffing Collaborative to collect, analyze for changes in the staffing plans.

No VFNHP member should be harassed, coerced, intimidated or discriminated against for signing a CFSS. Report any form of retaliation to VFNHP office immediately.

Step 1 of 2
IMPORTANT: Please do not include patient identifying information.
I have notified you that the staffing provided is not adequate to meet the needs of the patients on/in this unit/department at this time. Proper staffing has not been provided. Therefore, I am informing you that I am concerned in regards to any errors or incidents that take place as a result of the staffing level on this unit.



6/1 Bargaining Update

Nurses and Techs gathered in the McClure lobby to show solidarity with our Bargaining Team ahead of the 6/1 bargaining session. Contract negotiations have stalled, as we did not reach agreement at this week's session. VFNHP has given a package for the hospital to...

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5/11 Nurse Bargaining and Incentive Update

Last night, the VFNHP Bargaining Team spent over 3 hours hearing the same thing from management: The hospital will not agree to any financial proposals beyond the $1.3M for their charge and preceptor differentials proposals. Seven proposals, including increasing all...

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VFNHP Proposals 4/6/2022

Dear members,  Nurse contract bargaining began last night, and our Bargaining Team made 34 proposals across the table, while Management offered 11 proposals, only one of which was economic (Charge/Preceptor differential). Here are some of the highlights: Increased...

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Negotiations for all

At the opening of VFNHP-Nurse negotiations with the UVMMC administration, all of the VFNHP proposals were designed to:* Protect and improve patient care * Provide safety and respect * Improve benefits and compensation to recruit and retain nurses and support...

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Proposed Ophthalmology Career Ladder

Ophthalmology Techs have the opportunity to vote on updated job descriptions as well as an updated wage scale as part of career ladder negotiations. If approved, these changes would update our job descriptions to reflect our current practices, eliminate the OA I level...

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We are a strong union of health care professionals organized to ensure access to high-quality health care for everyone in the communities we serve.

Call: (802) 657-4040

Fax: 802.871.5946


Address: 121 Park Avenue #10 Williston, VT 05495