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Oregon OSHA - Hazard Reporting





Oregon OSHA only has jurisdiction over workplace safety and health issues.



If your complaint relates to enforcement of minimum wage or collection of wages owed, go to the Bureau of Labor and Industries, Wage and Hour Division: http://www.oregon.gov/BOLI/WHD/pages/index.aspx



For discrimination complaints, go to the Bureau of Labor and Industries, Civil Rights Division: http://www.oregon.gov/BOLI/CRD/pages/index.aspx



If you have a food safety concern, those issues are usually best addressed by a local county health department. Both the Oregon Health Authority and the Oregon Department of Agriculture regulate food borne illness: http://public.health.oregon.gov/HealthyEnvironments/FoodSafety/Pages/index.aspx



Please report the hazard in question using the form shown below.



Fields marked with * are required.



About The Employer's Business Employer's Name * Type of Business * Employer's Address * City, State, Zip * City: , State: Oregon, Zip: (5 digits) County * Telephone * Fax Employer's Email Address Where we can contact an employer representative. Retype Email Address Contact Person First Name * First name of the employer representative. Contact Person Last Name * Last name of the employer representative.

About The Hazard Description * Location of the Hazard * Street Address:

Where at the address is the

hazard (room, building …) This Was Reported To * My Supervisor The safety committee A coworker I haven't reported the hazard to anyone

About You If you select "Yes" to the question, "keep your identity confidential," the information below will not be provided

to the employer. Do you want to keep your identity confidential? * Yes No Which of the following describes you? *

We can't contact you or keep you informed unless you provide the following information.

First Name Last Name Your Email Address Retype Email Address Telephone Mailing Address City, State, Zip City: , State: Oregon, Zip: (5 digits)









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