VESSA Complaint Form 2026

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The document outlines the procedures for filing a complaint under the Victims' Economic Security and Safety Act (VESSA) in Illinois. It includes a Complainant Contact Sheet and a VESSA Complaint Form that must be completed and submitted to the Illinois Department of Labor, along with supporting documents. The instructions emphasize the importance of providing complete information to avoid delays in processing, as well as notifying the Department of any changes in contact information. The document also details employee rights regarding VESSA leave, including confidentiality, health benefits, and job restoration.

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Click ‘Get Form’ to open the VESSA Complaint Form in the editor.
Begin by filling out the Complainant Contact Sheet. Enter your first and last name, home phone number, address, city, state, zip code, work phone number, and email. Ensure all information is accurate.
Provide the name and contact number of someone who can reach you if necessary. This is important for maintaining communication throughout the process.
Proceed to the VESSA Complaint Form section. Fill in employer information including employer name, address, email, and contact details.
Complete the employee information section with your details again. Then answer questions regarding your terms of employment and any relevant complaints related to VESSA leave.
Review all sections carefully. Attach any required supporting documents as specified in the instructions before submitting your form.

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