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

Document Attachments:

ERD-13521-E (Electronic Version - Word/118 KB)

ERD-13521 (Print Version - pdf/31 KB)

*** If you need to access this form in an alternate format, please send an email to the Content Contact listed above.

*** Should you require the necessary software to view the above attachment, please go to the DWD Viewers Download Page.  Links to each specific vendor's site have been provided for you.  Thank you.

Email DWD DWD Photo Gallery DWD on Twitter DWD on Facebook DWD on YouTube DWD on LinkedIn DWD RSS Feed

A proud partner of the network