DOLI – Virginia Department of Labor and Industry - Office of Whistleblower Protection

The VOSH OWP investigates violations of Virginia Code § 40.1-51.2:1, which prohibits an employer from discriminating against an employee who has filed a safety or health complaint. If you have experienced discrimination from your employer based on your race, color, religion, sex (including pregnancy, sexual orientation, and gender identity), national origin, age, disability, or genetic information, please contact the Equal Employment Opportunity Commission at 1-800-669-4000.

Please fill out the form below in order to file a complaint.

Name(Required)

First Last

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Phone(Required)

Email(Required)

Employer’s Name

Employer’s Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Your Job Title

Date You Were Hired

What safety and health violations did you report?

Who did you speak to about the safety and health violations?

Did you file a safety/health complaint with a government agency? If so, please write the name of the agency and the case number.

How did your employer retaliate against you? (Fired, suspended, demoted, hours reduced, etc.)

When did your employer retaliate against you?

Did your employer give you a reason for the adverse actions? If so, what?

What are you seeking? (Reinstatement, back pay, neutral reference, expungement, etc.)

Provide a detailed timeline of what has happened since you complained about safety and health concerns.

Was this article helpful?

YesNo

Office of Whistleblower Protection | Initial Questionnaire