Last updated: 11/26/2025
Notice Of Alleged Health Or Safety Hazards
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Description
NOTICE OF ALLEGED SAFETY OR HEALTH HAZARDS. This form, issued by the Industrial Commission of Arizona (ICA), Division of Occupational Safety & Health (ADOSH), allows employees or their representatives to report unsafe or unhealthy working conditions in Arizona workplaces. The form collects detailed information about the employer, including name, address, type of business, and management contact, as well as a description of the alleged hazards and the number of affected employees. Complainants can indicate whether they wish to remain anonymous to prevent potential retaliation. Once submitted, ADOSH investigates the complaint under Arizona workplace safety regulations to ensure compliance with state and federal OSHA standards. www.FormsWorkflow.com
