NYCOSH

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: ____________________________________________________

 

UNION/ORGANIZATIONAL AFFILIATION: _________________________

 

EMAIL: ____________________________________________________

 

MAILING ADDRESS: _________________________________________

(street and apt. number)

__________________________________________________________

(city, state and zip code)

 

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

___________________________________________________

VOLUNTEER INFORMATION:

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:

 

_____Asbestos/Lead

_____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

_____OSHA

_____Radiation

_____Workplace Violence

_____Workers' Compensation

_____Young Workers 


_____Other

 

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

NYCOSH
116 John Street, Suite 604, New York, NY 10038
Phone: 212-227-6440
Fax: 212-227-9854
Email: nycosh@nycosh.org

___________________________________________________________________________________________

For NYCOSH internal use:

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