Workplace Safety Poster Request Form Advocacy Resources Federal Legislative Bill Tracker Legislative Action Center Legislative Bill Tracker COVID-19 Public Health Emergency Elections Election Materials Request Form Federal Issues 340B Drug Discount Program Finance Policy Issues Health Data Health Equity Michigan Harvest Gathering MHG Post Food Drive Report MHG Project Leader Sign Up Health PAC Key Issues Behavioral Health Healthcare Workforce Hospital Funding Crisis Nurse Staffing Ratios Rural Health State Budget Regulatory Issues Auto No Fault Insurance Certificate of Need Regulations Workplace Safety Poster Request Form The MHA is offering members a complimentary selection of workplace safety posters to communicate the consequences of committing physical harm toward healthcare workers or hospital property. Available are a variety of poster designs that are laminated and can be affixed behind any plastic or plexiglass barrier. Both 11” x 17” and 8.5” x 11” sizes are available. To request your materials, please complete this form. While there is no limit on the quantity of materials that may be requested, we do ask that you allow five working days for processing and delivery. If you have any questions, please contact the MHA.Requestor's Name(Required) First Last Phone(Required)Email(Required) Please indicate the quantities needed below for each poster design: Poster 1 (11" x 17")Total amount of 11" x 17" posters requested (Increments of 10):Poster 1 8.5” x 11”Total amount of 8.5” x 11” posters requested (Increments of 10):Poster 2 (11" x 17")Total amount of 11” x 17” posters requested (Increments of 10):Poster 2 (8.5” x 11”)Total amount of 8.5” x 11” posters requested (Increments of 10):Poster 3 (11" x 17")Total amount of 11” x 17” posters requested (Increments of 10):Poster 3 (8.5” x 11”)Total amount of 8.5” x 11” posters requested (Increments of 10):Poster 4 (11" x 17")Total amount of 11” x 17” posters requested (Increments of 10):Poster 4 (8.5” x 11”)Total amount of 8.5” x 11” posters requested (Increments of 10):This collection includes ten different variations of the design. Each order of ten (10) posters will include one poster for each image. Collection (11" x 17")Total amount of 11” x 17” posters requested (Increments of 10):Collection (8.5” x 11”)Total amount of 8.5” x 11” posters requested (Increments of 10):Shipping InformationName(Required) First Last Title Department Organization(Required) Shipping Address(Required) Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Special Delivery InstructionsNote: Forms will not be accepted if they include URLs.PhoneThis field is for validation purposes and should be left unchanged.