Form Wh-22 - Complaint Form - Bureau Of Labor And Industries Wage And Hour Division

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THIS INFORMATION
IS AVAILABLE IN AN
ALTERNATE FORMAT
Re: Your Complaint
Pursuant to your recent request, we are furnishing you with a Wage and Hour Complaint form
which is on the reverse side of this letter. This complaint form should be used to file complaints
relating to violations of wage and hour laws (such as failure to provide rest breaks or meal
periods, irregular paydays, failure to provide itemized pay statements, failure to provide timely
paychecks upon termination, etc.). This form may also be used to report apparent child labor law
violations (prohibited work hours or occupations for example).
Do not use this complaint form if your claim is for unpaid wages. If you are claiming unpaid
wages, complete a wage claim form which may be obtained at any office of the Bureau of Labor
and Industries or from the bureau’s website at
Please complete the complaint form completely and submit it to:
Bureau of Labor and Industries
Wage and Hour Division
800 NE Oregon Street #1045
Portland, OR 97232
When you return this complaint to us, the Bureau of Labor and Industries will seek compliance
with Oregon’s Wage and Hour laws by informing the employer of the requirements of the law
with respect to the alleged violations contained in the complaint.
Pursuant to the Public Records Law, the information provided on this complaint form, including
the name of the complainant, is disclosable and may be provided upon request to the business
against which the complaint is filed. However, to the extent permitted by the law, BOLI will not
disclose the complainant’s residential address, personal telephone numbers, and personal email
address if the complainant requests that this information remain confidential. While you are not
required to include your name or contact information on the complaint form, be advised that if
the information provided is not sufficient or there are any questions regarding the complaint and
we are unable to contact you, no further action may be taken.
Sincerely,
BUREAU OF LABOR AND INDUSTRIES
Wage and Hour Division
WH-22 (Rev. 5/17)

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