Kentucky Labor Cabinet
Department of Workplace Standards
Division of Occupational Safety and Health Compliance
Notice of Alleged Safety or Health Hazard
Date Submitted
* Employer Name
Site Location
* Street
* City
* State
(Select)
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District Of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
American Samoa
Guam
Northern Mariana Islands
Puerto Rico
U.S. Minor Outlying Islands
U.S. Virgin Islands
* Zip Code
Mailing Address (if different)
Street
City
State
(Select)
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District Of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
American Samoa
Guam
Northern Mariana Islands
Puerto Rico
U.S. Minor Outlying Islands
U.S. Virgin Islands
Zip Code
Alleged Safety or Health Hazard Details
* Type of Business
Manufacturing
Construction
Warehousing
Transportation
Nursing Home
Healthcare
Government
Other
* Hazard No. 1 description:
* Who and how many are exposed to the hazard?
* What specifically is the hazard?
* When did the hazard happen?
* Is the hazard ongoing now?
Yes
No
* Where is the hazard located?
* Do you have another hazard?
Yes
No