Nys pesh complaint form: Fill out & sign online

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Click ‘Get Form’ to open the pesh complaint in the editor.
Begin by filling in the 'Establishment Name' and 'Site Address' fields. Ensure accuracy as this information is crucial for processing your complaint.
In the 'Hazard Description/Location' section, describe each hazard in detail. Specify the exact location within the worksite and include any evidence that supports your claims, such as recent accidents.
Indicate whether this condition has been reported to anyone by checking the appropriate box. This helps clarify previous actions taken regarding the hazards.
Complete your personal details in the 'Complainant Name' section, including your contact information. Choose whether you want your name revealed to your employer.
Finally, review all entries for accuracy before signing and dating the form. Once completed, submit it to the nearest DOSH district office listed at the bottom of the form.

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