Section 1 (Your Details)

Please note: We may need to contact the employer subject to your complaint to seek a response. We cannot accept anonymous complaints as we generally need to follow up with the complainant to seek additional details. Your personal information will be kept confidential and we will not give your name or contact details to the employer or any third party without your permission. However, we will need to give the employer general details about your complaint. By ticking the box you are giving your consent to use the information provided by you in this way.

Section 2 (Workplace Details)

Place of work (location details of where breaches of safety and health are observed)

Section 3 (Complaint)