REPORT MISCLASSIFICATION

To report a misclassification issue, please complete the following form. The required fields are marked with an asterisk (*).
These fields must be completed in order to submit your misclassification issue.

Learn more about misclassification

Business Information

Business Name *

Business Address

Business City

Business State

Business Telephone #

Business Type

Business Contact Name (e.g. Owner, Boss, Supervisor) *

Job Site Address (Street/Location) *

Job Site City *

Job Site State *

When did you observe this or when did it occur?* *

Explain what occurred *

Contact Information

Providing this contact information will assist in completing a more thorough investigation. It is our policy to keep such information confidential to the maximum extent allowed by law.

Your First Name

Your Last Name

Your Street Address

Your City

Your State

Your Telephone #

Your Email Address

REPORT MISCLASSIFICATION

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