OSHA-7 ONLINE COMPLAINT FORM
(For North Carolina Businesses only)

Notice of Alleged Safety or Health Hazards

How to File an OSH Complaint

Please READ THIS before filling in sections 1 through 18.
Items in red must be completed in order to accept your submission.

1. Establishment Name:
NOTE: In order for OSH to fully process your complaint, complete and accurate information about the worksite is necessary.
2. Site Street:
3. Site City:
4. Site Zip Code:
5. Mailing Address (if different):
6. Management Official:
7. Telephone Number:	(include area code)
8. Type of Business:
9. Hazard Description: Describe briefly the hazard(s) which you believe exist. Include the approximate number of employees exposed to or threatened by each hazard:
10. Hazard Location: Specify the particular building or worksite where the alleged violation exists:
11. This condition has been brought to the attention of:(Choose all that apply) Employer  Other Government Agency (specify)
12. I am a(n): Employee  Representatives of Employees  Other
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.
13. Complainant Name:
14. Complainant Telephone No:
15. Complainant Mailing Address:
Street:
City:
State
Zip Code:
16. Complainant E-mail Address:
17. 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:
Organization Name:
Your Title:

Punishment for unlawful statements

Potential complainants should keep in mind that it is unlawful to make false statements, representations, or certifications associated with any complaint (NCGS §95-139). Violations of this statute are a Class 2 misdemeanor in the state of North Carolina and are punishable by a fine of up to $10,000.

 

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