WEST VIRGINIA DIVISION OF LABOR

Request for Investigation Form
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Section 1 - Complainant Information

Section 2 - Company / Issue to be Investigated:

Your relationship/concern in this matter is as:

Private	Representative of
Competitor	Other (Describe):
Please describe the issue you request to be investigated. Remember to include company and/or individual names when applicable and directions to site/location to be investigated. Be specific in your explanation and identify the violation of law alleged:
Project Start Date:		Completion Date:

Please check if you want notified, via email only, when the intial investigation has been conducted.

Instructions

Section 1 must be completed in full for your complaint to be investigated.

Anonymous requests will not be processed.

After filling out this form, click "Submit to Department of Labor" if you want to automatically send this form to the Department of Labor click "Download Filled PDF Form" to create a downloadable PDF that you can save to your computer.