Illinois OSHA Safety and Health Complaint Form

Note: Illinois OSHA only has jurisdiction over public sector employers . Examples of public sector employers include: municipal employers (example: public works departments), city employers (example: police and fire departments) , county employers (example: Cook County Health and Hospital Systems), State of Illinois offices and agencies (example: Illinois Department of Transportation, State Board of Education, Illinois Tollway Authority, Illinois Department of Public Health). If your complaint is about a private sector employer (example: gas stations, manufacturer, retail business establishment, restaurant, etc) then you must contact Federal OSHA, who has jurisdiction over all private sector businesses and establishments. They can be reached by calling 1-800-321-OSHA (6742) or by visiting:

 Notice of Alleged Safety or Health Hazards Form

 For the Illinois Public Sector

This condition has been brought to the attention of: (Choose all that apply) Required
Please indicate your desire: RequiredThe OSHA Act gives complainants the right to request that their names not be revealed to their employer. Providing your name and address will only allow Illinois OSHA staff to communicate with you regarding your complaint
I am a(n): Required