F418-052-000 Alleged Safety or Health Hazards - Labor & Industries - lni wa 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering the date you are filling out the form in the designated field.
3. Input the legal name of your employer in the 'Employer Name' section.
4. Provide the site location, including street address, city, state, and ZIP code.
5. If applicable, enter a different mailing address for the employer.
6. Fill in the name of a management or supervisory official responsible at your workplace.
7. Enter a business telephone number where you can be reached.
8. Describe the type of business being conducted at your workplace clearly and concisely.
9. Detail any hazards you believe exist, specifying who is affected and what actions have been taken by the employer regarding these hazards.
10. Indicate if this unsafe condition has been reported to anyone else and provide their details if necessary.
11. Mark whether you wish to keep your identity confidential when submitting this complaint.
12. Complete your personal information including name, phone number, and address for follow-up purposes before signing and dating the form.

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