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Form for Employees Regarding Perceived Health or Safety Violations

Author: Ashley Shaw, XpertHR Legal Editor

When to Use This Form

Sometimes, employees will notice health or safety violations that may have gone unnoticed by the employer. In these situations, the employee has the right to make a complaint to OSHA. However, employers may want to encourage employees to come to it first. This way, the employer has the opportunity to fix the violation without an OSHA citation. This form can be used by employees to let employers know when a safety or health violation may have been committed.

Customizable Form