Sign up, stay informed, and get active in the fight for safe

and healthy jobs.

(Please copy or print this form and return via email, fax or mail to the contact information listed at the bottom of page)

___Please add me to NYCOSH’s email list so I can be notified of health and safety news, upcoming trainings, events, legislative campaigns and other activities and actions that advocate for the human right of every worker to a safe and healthful workplace.

___I would like to volunteer. Please see what I have checked below on how I can contribute.

NAME: ____________________________________________________




EMAIL: ____________________________________________________


MAILING ADDRESS: _________________________________________

(street and apt. number)


(city, state and zip code)


PHONE NUMBER, including area code (required for volunteers):________________________________________________



I can do the following:


_____ I can work with others to develop support for action

(name your issue of interest) _____________________________________


_____ I can help write grants


_____ I can do research to help to identify possible grant funding


_____ I can do research or help write testimony for public hearings on health and safety issues, or help write new draft standards


_____ I can conduct training on health and safety topics of interest

(issue(s)) _________________________________________________


_____ I can help write factsheets on ___________________ (your area(s) of interest) that can be put up on the website


_____I can be part of a NYCOSH speakers’ bureau and can attend city council and community board hearings on relevant topics


_____I can help write reports (i.e., a yearly report on the state of H&S in NYS…)


_____ I can do some fundraising


_____ I can help to bring in new members to NYCOSH


_____ I can host a house party to raise money for NYCOSH


_____ I can translate materials (language) __________________________


_____  Other ideas (list here)





Topics of interest:



_____Immigrant H&S

_____Chemicals/Haz Comm/Right-to-Know

_____Construction Hazards

_____Disaster Preparedness/emergency Response

_____Ergonomics/Musculoskeletal Disorders

_____Green Job Hazards

_____Hazardous Waste

_____Health & Safety committees

_____Health & Safety legislation  

_____Indoor Air Quality/Mold                                                

_____Infectious Diseases/Pandemics



_____Workplace Violence

_____Workers' Compensation

_____Young Workers 



Please return this form via mail, fax or by scanning it into an email to:

116 John Street, Suite 604, New York, NY 10038
Phone: 212-227-6440
Fax: 212-227-9854


For NYCOSH internal use:

Trainer: _____ DOT: ________   DB:  _______   CC: _____

NYCOSH Offices:

New York City
61 Broadway - Suite 1710
NY, NY 10006
(Fax) 212-227-9854

Long Island
150 Motor Parkway - Suite 306
Hauppauge, NY 11788
(Fax) 631-435-1893