Safety Complaints | Vermont Department of Labor

VOSHA
Online Complaint Form
Notice of Alleged Safety or Health Hazards

EMERGENCY NOTICE: Do Not Report an Emergency Using This Form or Email!

To report an emergency, fatality, or imminent life threatening situation please contact our toll free number immediately:
1-800-287-2765

NOTE: In order for VOSHA to fully process your complaint, complete and accurate information about the worksite is necessary.

Establishment Name*
Site Physical Address*
Street AddressAddress Line 2CityZIP Code
Mailing Address (If different)
Street AddressAddress Line 2CityZIP Code
Management Official
FirstLast
Phone
Type of Business
Hazard Description*
Describe briefly the hazard(s) which you believe exist. Include the approximate number of employees exposed to or threatened by each hazard.
Hazard Location*
Specify the particular building or worksite where the alleged violation exists
This condition has been brought to the attention of: (Choose all that apply)
- Employer
- Government Agency
I am a(n):
- Employee
- Representative of Employees
Please indicate your desire:
The VOSHA Act gives complainants the right to request that their names not be revealed to their employer. Providing your name and address will only allow VOSHA staff to communicate with you regarding your complaint.
- Do NOT reveal my name to my Employer
- My name may be revealed to my Employer
Complainant name*
FirstLast
If this box is checked, this submission shall be considered as an authorized written signature.
- This constitutes my electronic signature.
Complainant email address*
Complainant Telephone Number*
Complainant Mailing Address*
Street AddressAddress Line 2CityStateZIP Code
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

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