Federal and state regulations require your employer to provide a safe workplace. OSHA and the Centers for Disease Control have issued guidance that employers should follow to help keep their employees safe from coronavirus.

The form below helps people whose employers are not following the recommended guidance of OSHA and the CDC related to coronavirus. The form is not legal advice. You can use this form to request that your employer take steps to make your workplace safer from coronavirus by completing the sections in the downloadable PDF and providing it to your employer.

Before you make a complaint

It is best to raise your health and safety concerns together with at least one other concerned coworker. When two or more people in a workplace complain about a health or safety concern, their complaint is considered collective action and is considered protected activity under federal law. It is also important to keep your own copy of anything you provide to your employer. Detach the form from the rest of the downloadable document before you deliver it to your employer.

Need help?

If you need help filling out the form, or have questions about how to deliver it to your employer, contact Ana Pardo: ana.pardo@ncjustice.org