If you're a worker who is making a complaint about an employer’s failure to pay wages for duties related to workplace health and safety, as required by the Occupational Health and Safety Regulation, please use this form to submit your complaint to us.

You can complete this form digitally or print it and complete it by hand. If you’d like to complete this form digitally, you must use Adobe Acrobat. If you don’t already have Acrobat on your computer, you can download Adobe Acrobat Reader, a free app, from get.adobe.com/reader.