Complaint Forms

California

San Francisco Employee Questionnaire & Declaration in Support of Claim (English)

Oakland Minimum Wage Complaint Form (Other Languages)

Emeryville Minimum Wage and Paid Sick Leave Ordinance Complaint Declaration Form (Spanish)

Emeryville Minimum Wage and Paid Sick Leave Ordinance Complaint Declaration Form (English)

Emeryville Minimum Wage and Paid Leave Complaint Form

California How to File a Wage Claim

Oakland Minimum Wage Complaint Form (English)

San Francisco Employee Questionnaire & Declaration in Support of Claim (Other Languages)

Los Angeles Minimum Wage and Paid Sick Leave Complaint Form (English)

San Diego Earned Sick Leave and Minimum Wage Complaint Declaration Form (English)

San Diego Earned Sick Leave and Minimum Wage Complaint Declaration Form (Other Languages)

California Initial Report or Claim Intake Form

Los Angeles Minimum Wage and Paid Sick Leave Complaint Form (Spanish)

Connecticut

Connecticut Department of Labor Workplace Standards Complaint Form

District of Columbia

D.C. Department of Employment Services Accrued Sick and Safe Leave How to File a Claim

Massachusetts

Massachusetts Non-Payment of Wage and Workplace Complaint Form

New Jersey

Trenton Paid Sick Leave Ordinance Intake Questionnaire (English)

Trenton Paid Sick Leave Ordinance Intake Questionnaire (Spanish)

New Brunswick Paid Sick/Safe Leave Ordinance Complaint Form

Plainfield Paid Sick Leave Ordinance Intake Questionnaire (English)

Plainfield Paid Sick Leave Ordinance Intake Questionnaire (Spanish)

New York

New York City Department of Consumer Affairs Sick Leave Intake Form

New York City Count of Sick Leave Complaints and Investigations

Oregon

Portland Sick Time Complaint Form (English)

Portland Sick Time Complaint Form (Spanish)

Pennsylvania

Philadelphia Promoting Healthy Families and Workplaces Paper Complaint and Intake Form

Pennsylvania

Pittsburgh Paid Sick Day Complaint Form

Washington

Seattle Office for Civil Rights Complaint Form

Tacoma Paid Leave Inquiry Form