Notice of Alleged Occupational Safety and Health Hazards - Instruction/Handling

For the General Public:

The Department of Consumer and Industry Services has developed this NOTICE in order to promptly and efficiently investigate the nature and extent of those conditions which you feel are creating a hazard to safety or health or otherwise violate Michigan's Occupational Safety and Health Standards. This NOTICE is not intended to constitute the exclusive means by which a complaint may be filed.

Section 28(1) of Michigan's Occupational Safety and Health Act (Act 154, P.A. 1974) describes the procedures by which complaints may be filed and the actions which will be taken by the Department. An employee or employee representative who believes that a violation of a safety or health standard exists that threatens physical harm to an employee, or that an imminent danger exists, may request an inspection by giving written notice of the condition to the department. The notice shall be reduced to writing, shall set forth with reasonable detail the grounds for the request, and shall be signed by the employee or employee representative giving the notice. A copy of the complaint shall be provided to the employer or his agent not later than at the time of the inspection. Upon the request of the person giving the notice, his or her name and the names of employees referred to therein shall not appear in the copy or on the record which is published, released, or made available. If the department determines that there are no reasonable grounds to believe that an inspection should be conducted, it shall notify, in writing, the complainant of its determination.

Sections 65(1) and (2) make it unlawful for an employer to discharge or in any manner discriminate against an employee for filing a complaint with the Department or exercising any other rights provided by the act. Any employee who believes that they may have been discharged or otherwise discriminated against by a person in violation of this section may file a complaint with the department alleging the discrimination within 30 days after the violation occurs.

INSTRUCTIONS:

Complete the "Notice of Alleged Safety or Health Hazards" form as accurately as possible. Describe each hazard you think exists in as much detail as you can. If the hazards described in your complaint are not all in the same area, please identify where each hazard can be found at the worksite. If there is any particular evidence that supports your suspicion that a hazard exists (for instance, a recent accident or physical symptoms of employees at your site) include the information in your description. If you need more space than is provided on the form, continue on another sheet and attach.

If your complaint issues are mostly safety related, return the completed form to:

If your complaint issues are mostly health related, return the completed form to:

MI DEPARTMENT OF CONSUMER & INDUSTRY SERVICES
BUREAU OF SAFETY AND REGULATION
OCCUPATIONAL HEALTH DIVISION
7150 Harris Drive
P O BOX 30649
LANSING MI 48909-8149
TELEPHONE: (517) 322-1608

NOTE: It is unlawful to make any false statement representation or certification in any document filed pursuant to the Michigan Occupational Safety and Health Act of 1974, as amended. Violations can be punished by a fine of not more than $10,000, or by imprisonment of not more than six months, or by both (Section 35(7)).