Public Employees Occupational Safety and Health Complaint Form

Public Employees Occupational Safety and Health
Complaint Form

The State of New Jersey adopted the Public Employees Occupational Safety and Health (PEOSH) Act to ensure safe and healthful workplaces for New Jersey public employees. Under the Public Employees Occupational Safety and Health Act (N.J.S.A. 34:6A-25 et seq.):

Any employee, group of employees or employee representative who believes that a violation of a health and safety standard exists, or that an imminent danger exists, may request an inspection by giving notice to the appropriate commissioner. The notice and request shall be in writing, shall set forth the grounds for the notice and shall be signed by the employee, a group of employees, or employee representative. The appropriate commissioner shall encourage any employee, group of employees or employee representative who believes that a violation of a health or safety standard exists, or that imminent danger exists, to report that violation or danger in the first instance to the employer's safety officer.

NOTE: No person shall discharge, or otherwise discipline, or in any manner discriminate against any employee because of the exercise by such employee on behalf of himself or others of any right afforded by the act.

The OCC-57 Complaint form (Word 49KB or PDF 16KB) is provided for the assistance of any person in making a complaint to the Department of Labor or the Department of Health and Senior Services, and is not intended to constitute the exclusive means by which a complaint may be submitted.

Occupational safety and health complaints under the Public Employees Occupational Safety and Health (PEOSH) Act are investigated by two state agencies:

The Department of Labor handles complaints regarding safety.
The Department of Health and Senior Services handles complaints regarding health hazards.

Please mail your signed complaint form to the appropriate agency. If you have any questions, please call. We will forward your complaint to the appropriate agency if you are uncertain as to which agency responds to your concerns.

Safety Complaints	Health Complaints
New Jersey Department of Labor Office of Public Employees Safety PO Box 386, Trenton, NJ 08625 Phone: (609) 292-7036, Fax: (609) 292-3749	New Jersey Department of Health and Senior Services PEOSH Program PO Box 360, Trenton, NJ 08625 Phone: (609) 984-1863, Fax: (609) 984-2779

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Updated: December 2005