[email protected] to the Directorate of Whistleblower Protection Programs, Department of Labor, Room N4624, 200 Constitution Ave., NW, Washington, DC; 20210; Attn: Paperwork Reduction Act Comment.
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.
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.
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.
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.
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