OSHA Online Whistleblower Complaint Form

EMERGENCY NOTICE: Do Not Report an Emergency Using this Form or Email!

To report an emergency, fatality, or imminent life threatening situation please contact our toll free number immediately:

1-800-321-OSHA (6742)

TTY 1-877-889-5627

Introduction & Instructions

OSHA administers more than twenty whistleblower protection laws, including Section 11(c) of the Occupational Safety and Health (OSH) Act, which prohibits retaliation against employees who complain about unsafe or unhealthful conditions or exercise other rights under the Act. Each law has a filing deadline, varying from 30 days to 180 days, which starts when the retaliatory action occurs.

A whistleblower complaint must allege four key elements:

The employee engaged in activity protected by the whistleblower protection law(s) (such as reporting a violation of law);
The employer knew about, or suspected, that the employee engaged in the protected activity;
The employer took an adverse action against the employee;
The employee's protected activity motivated or contributed to the adverse action.

Filing with this form is not required, as OSHA accepts whistleblower complaints made orally (telephone or walk-in at any OSHA office) or in writing, and in any language. If you choose to use this form, you must complete the screens and fields that are marked as "required"; all other screens and fields are optional.

If you file a complaint, OSHA will contact you to determine whether to conduct an investigation. You must respond to OSHA's follow-up contact or your complaint will be dismissed.

A whistleblower complaint filed with OSHA cannot be filed anonymously. If OSHA proceeds with an investigation, OSHA will notify your employer of your complaint and provide the employer with an opportunity to respond. Because your complaint may be shared with the employer, do not include witness names or their contact information on this form; you will have the opportunity to offer evidence in support of your complaint during the investigation.

If you have any questions about the complaint filing or investigative processes, please do not hesitate to call 1-800-321-OSHA (6742) or contact your local OSHA office.

If you think your job is unsafe and you want to ask for an inspection, you can call 1-800-321-OSHA (6742), or file a "Notice of Alleged Safety or Health Hazards" by clicking here.

Do you want to file an online whistleblower complaint now?

Yes, Launch the Online Whistleblower Complaint Form

No Return to www.whistleblowers.gov

How can OSHA contact your employer?

Employer Name (if different from "Company Name" above):

Name and Title of Management Person (for contact purposes only)

Name:

Title:

Phone:

Ext

Name and Title of Your Supervisor:

Name:

Employer Mailing Address (if different from worksite address, i.e., Corporate or Headquarters, etc.):

Street:

State:

City:

Zip:

Employer Phone:

Alt Phone:

Employer Fax:

Alt Fax:

Employer Email:

Type of Business:

Continue to the next section

Cancel, Return to www.whistleblowers.gov

How can OSHA contact you?

Please complete all required fields

Name (Required):

Mailing Address (Street, City, State, Zip) (Required):

Street:

State:

City:

Zip:

Telephone Numbers (include area code) (at least one required):

Home:

Work:

Ext

Cell:

No Telephone Available

Email Address (Required):

Confirm Email Address (Required)

Other Contact Person?

Name:

Phone:

Preferred Method of Contact:

Preferred Time of Contact:

Do you require the use of a translation service to speak with an OSHA Representative?

Yes (specify language)

Continue to the next section

Cancel, Return to www.whistleblowers.gov

Designated Representative

Do you have an authorized / designated representative (e.g., attorney, shop steward)?

Yes

Are you an authorized / designated representative (e.g., attorney, shop steward) that is filing on behalf of an employee?

Yes

If yes for either, please provide contact information for the authorized/designated representative:

Name:

Title:

Organization Name (if any):

Union Affiliation (if any):

Address (Street, State, City, Zip Code):

Street:

State:

City:

Zip:

Phone (day):

Ext

Email:

By checking this box, I certify that the named employee has authorized me to act as their representative for purposes of this complaint.

Continue to the next section

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PLEASE FILL OUT ALL REQUIRED FIELDS

PRIVACY ACT STATEMENT

This form requests personal information that is relevant and necessary to determine whether and how to conduct an investigation. OSHA collects this information in order to process complaints under its statutory and regulatory authority. Once a complaint is filed, the individual's name and information about the allegations of retaliation will be disclosed to the employer. During the course of an OSHA investigation, information contained in an investigative case file may be disclosed to the parties in order to resolve the complaint. During an investigation, information about the complaining party and the employer will not be released to the public except to the extent allowed under the Freedom of Information Act (FOIA). However, once a case is closed, it is possible that information contained in the complaint or a case file may be released to the public as required by the FOIA. Any such documents will be redacted as appropriate under the FOIA and the Privacy Act.

PAPERWORK REDUCTION ACT STATEMENT

According to the Paperwork Reduction Act, an Agency may not conduct or sponsor, and no persons are required to respond to a collection of information unless such collection displays a valid OMB control number. Public reporting burden for this voluntary collection of information is estimated to be one hour per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Please send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to OSHA.DWPP@dol.gov or to the Directorate of Whistleblower Protection Programs, Department of Labor, Room N4624, 200 Constitution Ave., NW, Washington, DC; 20210; Attn: Paperwork Reduction Act Comment. (This address is for comments only; do not send completed complaint forms to this office.)

OMB Approval # 1218-0236; Expires: 03-31-2027

OSHA 8-60.1. (Rev.10/22).

Occupational Safety and Health Administration