OSHA - Notice of Alleged Safety Violation Mobile App

Take a peek inside the OSHA - Notice of Alleged Safety Violation Mobile App

Included Features

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Included Fields

Customize to add, remove, or edit any of the fields below.

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  First Name

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  Last Name

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  Email

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  Current Location

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  Type of Business:

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  Site Address

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  Management Official:

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  Establishment Name

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  Mailing Address (if different)

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  Telephone

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  Describe briefly the hazards(s) which you believe exist.

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  Hazard Location Specify the particular building or worksite where the alleged violation exists:

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  This condition has been brought to the attention of: (Enter all that apply)

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  I am a(n):

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  Employee

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  Federal Safety and Health Committee

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  Representative of Employees

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  Other: (specify)

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  The OSH Act gives complainants the right to request that their names not be revealed to their employer.

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  Please indicate your desire:

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  Complainant name

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  Complainant address

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  Complainant telephone

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  Complainant email address

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  If you are an authorized representative of employees affected by this complaint, please state the name of the organization that you represent and your title:

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  Potential complainants also should keep in mind that it is unlawful to make any false statement, representation, or certification in any complaint.

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  Public reporting burden for this voluntary collection of information is estimated to vary from 15 to 25 minutes per response with an average of 17 minutes 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.

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  Date

• ...and More!