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Occupational Safety And Health Complaint Form

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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.

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 and Workforce Development 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

NJ Department of Labor & Workforce Development

NJ Department of Health & Senior Services

Office of Public Employees Safety

PEOSH Program

P.O. Box 386

P.O. Box 360

Trenton, NJ 08625-0386

Trenton, NJ 08625-0360

Phone: (609) 984-1863

Phone: (609) 292-7036

Fax: (609) 292-3749

Fax: (609) 984-2779

Occupational Safety And Health Complaint Form

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