COVID-19 Worker Protection Complaint Form

Important information before filing your complaint:

Executive Order 192 imposes requirements on every employer-business, non-profit, governmental and educational entities to take steps to prevent the spread of COVID-19 to employees, customers and others who come into physical contact with its operations. The requirements address such measures as social distancing, the wearing of face masks, health checks and the cleaning and disinfecting of high touch areas. The full text of Executive Order 192 is available here.

If you believe that an employer has created an unhealthy or unsafe workplace due to its failure to meet any of the requirements of Executive Order 192 you may use this form to file a complaint with the New Jersey Department of Labor and Workforce Development's Division of Public Safety and Occupational Safety and Health (PSOSH).

It is unlawful for your employer to retaliate against you for filing a complaint. Your identity and other personally identifiable information shall be kept confidential to the extent practicable except where disclosure is deemed necessary for the enforcement of any State or Federal law.

If you choose to file a complaint anonymously, you will not get status updates about your claim and neither you nor anyone else will receive any information about the claim.

This form serves workers in the private sector. If you are covered by the Public Employees Occupational Safety and Health Act, please use the existing intake process reserved for public employees (both state and local). You can choose to file with Department of Health here or with Department of Labor here.

If you have COVID-related concerns that are not about workplace safety and health, please visit: https://covid19.nj.gov/forms/violation.

To submit a health and safety violation happening at a NJ workplace, please complete the form below.

*Indicates a required field.

The following questions are about the workplace:
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4.Zip Code of Unsafe Work Location *
(After entering ZIP please click TAB to auto populate City, State and County)
5.City
6.State
7.Describe unsafe work situation*
8.Are you filing a complaint on behalf of yourself about your workplace? *    Yes  No
9.Are you a union/worker representative filling on behalf of an employee or multiple employees?*    Yes  No

The following questions are about you, the employee, or your union/worker representative who is filing: