YouTube content moderators are being told to sign waivers acknowledging that performing their jobs could cause post-traumatic stress disorder (PTSD), according to a report by The Verge.

The report found that those refusing to sign have been threatened with employment termination.

Content moderators are responsible for monitoring material uploaded on social media platforms and are often exposed to a high volume of extremely disturbing images, which can be of a violent or sexual nature.

Accenture, the contractor responsible for hiring YouTube’s moderators, said that worker well-being was  a “top priority”.

Accenture is a professional services business, clients of which include Twitter, Google and Facebook. The company said only new employees were being asked to sign the document, while existing workers were being sent the form as an update.

“We regularly update the information we give our people to ensure that they have a clear understanding of the work they do,” Accenture said in a statement.

“I understand the content I will be reviewing may be disturbing,” the document reads. “It is possible that reviewing such content may impact my mental health, and it could even lead to Post Traumatic Stress Disorder (PTSD).

“I will take full advantage of the weCare program and seek additional mental health services if needed. I will tell my supervisor/or my HR People Adviser if I believe that the work is negatively affecting my mental health.”

According to The Verge, Accenture said it does share information about potentially explicit content with all its full-time and outside contractors who work on its Facebook and Twitter contractors. However, the company would not say whether or not it specifically warns workers they could develop PTSD because of the role.

A spokeswoman for Twitter said that both full-time and contract staff are informed when they join Twitter they may have to view objectionable material as part of their role. It is unclear if Facebook or Twitter employees have been asked to sign the acknowledgement form.

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As noted by The Verge, the language in the form place the onus on the employee to monitor their mental health. The document states that it the employee’s responsibility to self report negative impacts to their supervisor or HR representative, and to seek outside help if necessary.

“I understand how important it is to monitor my own mental health, particularly since my psychological symptoms are primarily only apparent to me,” the document reads.

“If I believe I may need any type of healthcare services beyond those provided by [Accenture], or if I am advised by a counselor to do so, I will seek them.”

The document adds that “no job is worth sacrificing my mental or emotional health” and that “this job is not for everyone”.

Employment lawyers have expressed concern over the language used in the waiver saying it could be construed by employees that they may be terminated for suffering mental health problems.

The document comes amid a rising number of moderators suffering from mental health problems and a number of lawsuits by former content moderators in the US and Ireland.

Previous reports have claimed that moderators have turned to drugs and alcohol to cope with the horrific content they are exposed to, while others become addicted to explicit material.