Report of Violation

Report of Violation

Use this form if an employer has failed to pay or provide sick and safe time, minimum wage, overtime or other wage theft protections in Minneapolis.

Is your worksite in Minneapolis (not a suburb)?:*

Yes

Unsure

Name:

Phone:

Email (or mailing address, if preferred):

Workplace/ Business name:

Workplace/ Business address:

Briefly describe what happened (who, what, when etc.):

Are there other people we should talk to about this? Who?

If a third party helped you complete this form, please provide name and/or organization:

Has the employer been made aware of the law?

Yes

Don't know

Industry/Occupation

Select

Submit supporting documents:

Drag and drop files here or

Preferred language

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Racial or ethnic identity (optional)

Select all that best describe you. This is not required. Data is only used to help us serve all communities well.

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(Optional) Complaint of Discrimination

Additionally, I believe that this incident was the result of discrimination based upon a protected class (race, sex, national origin, disability, sexual orientation and more) and would ALSO like it to be considered for a potential charge of discrimination.

Check if you wish to ALSO report discrimination.

Send me a copy of my responses

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