Notice of Alleged Safety or Health Hazard

Submitted by ichoyle on

This is to be completed only for businesses or employers in North Carolina.

Indicates required field
Is the site location and mailing address the same?
Mailing Address

Describe briefly the hazard(s) which you believe exist. Include the approximate number of employees exposed to or threatened by each hazard.

Specify the particular building or work site where the alleged violation exists.

This condition has been brought to the attention of
I am a(n)

Status message

It is the policy of OSH not to reveal the names of complainants to the employer.  However, providing your name and telephone number to our department will enable us to provide you with inspection/investigation findings, and assist you if questions arise.

Reveal or Do Not Reveal My Name

The OSH Act gives complainants the right to request that their names not be revealed to their employer. Providing your name and address, will only allow NCDOL staff communicate with you regarding your complaint.

Complainant contact
Are you an authorized representative of employees affected by this complaint?
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