Retaliation Complaint - Elder Abuse/Health Care Worker Laws
Document Number: ERD-13521-E
Description: This form should be used to file a complaint of discharge, retaliation or discrimination under any of the five laws regarding employment protection for people who report elder abuse or certain other similar concerns, or cooperate with government agencies regulating the health care industry.
Comments: This form must be signed by Complainant or authorized representative.
Content Contact: Equal Rights Information
ERD-13521-E (Electronic Version - Word/132 KB)
ERD-13521 (Print Version - pdf/135 KB)
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