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How to use or fill out How to File a Complaint with MIOSHA - State of Michigan

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Click ‘Get Form’ to open it in the editor.
Begin by filling in your personal information in the 'Complainant' section, including your name, date of hire, address, and contact details.
Indicate your current employment status by selecting from options such as 'Still Employed', 'Laid Off', 'Discharged', or 'Suspended'.
Provide details about your employer, including their name, address, and contact number. Also, specify the number of employees and average hours worked.
Complete the sections regarding your job title, department, supervisor's name, and whether you have filed any grievances or complaints related to safety or health.
Detail the discrimination incident by entering the date and time it occurred and explaining why you believe you were discriminated against.
Summarize events related to your complaint in the designated area. If necessary, attach additional sheets for more information.

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