By completing this form and signing up to join the Heart of Safety Coalition, I attest:

• I will do my best to uphold, evangelize and advance the concepts outlined in the Heart of Safety Declaration of Principles and the practices that support them.

• I am a licensed clinician, OR

• I work at a hospital, health system, clinic, or other healthcare delivery organization, OR

• I work at a non-profit, foundation, association, or government agency that has among its aims the advancement of healthcare team member safety and wellbeing.

By attesting, I agree to receive the Heart of Safety newsletter and information about the Coalition’s news, events, podcast, research and resources.