ࡱ> IKH7 zbjbjUU >7|7|)l```` 8  x & & & & 9dql$\ |Q59``& & `(`8& & & l pKB} L<v0LQHL````Virginia Department of Labor and Industry Occupational Safety and Health Compliance Notice of Alleged Safety or Health Hazards Complaint NumberEstablishment Name FORMTEXT      Site Address FORMTEXT      Site Phone FORMTEXT      Site FAX FORMTEXT      Mailing Address FORMTEXT      Mail Phone FORMTEXT      Mail FAX FORMTEXT      Management Official FORMTEXT      Telephone FORMTEXT      Type of Business FORMTEXT      HAZARD DESCRIPTION/LOCATION. Describe briefly the hazard(s) which you believe exist. Include the approximate number of employees exposed to or threatened by each hazard. Specify the particular building where the alleged violation exists.  FORMTEXT        FORMTEXT additional information Has this condition been brought to the attention of: FORMCHECKBOX  Employer  FORMCHECKBOX  Other Government Agency (specify)Please Indicate Your Desire:  FORMCHECKBOX  Do NOT reveal my name to my Employer  FORMCHECKBOX  My name may be revealed to the EmployerThe Undersigned believes that a violation of an Occupational Safety or Health standard exists which is a job safety or health hazard at the establishment named on this form.(Mark X in ONE Box)  FORMCHECKBOX  Employee  FORMCHECKBOX  Representative of Employees  FORMCHECKBOX  Other (Specify)  FORMTEXT      Complainant Name  FORMTEXT      Telephone  FORMTEXT      Address (Street,City,State,Zip)  FORMTEXT      Signature Date FORMTEXT      If you are an authorized representative of employees affected by this complaint, please state the name of the organization that you represent and your title:Organization Name:  FORMTEXT      Your Title: FORMTEXT       VOSH-7 (3/01) TVjlnxz*,.8:^`tvx,.BDFPRhj~jUj,UjUjDUjUj\UjUjtUjUmHnHujU jUCJAZ*,.TWQ$Ifu$$Ifl0^$b  &04 la$If 0]^00^00^0 #6$Z$$%R&0]^0 RtxT|~r$$Ifl00$  &04 la$If<$Ifr$$Ifl00$  &04 la<>^:44$If$$Ifl4r0 B$F 2&&&04 la$Ifr$$Ifl00$  &04 la,Th:4444$If$$Ifl4r0 B$F 2&&&04 laZTT$If$$Ifl\0B$ F &&04 la      _ ` n o p      4 6 8 P R n p r j^UjUjvUjUjUjUjU mHnHujUjUCJjUmHnHujU jU; %,a$$Ifl40$'  &04 la$Ifr$$Ifl00$  &04 la  ! " # $ % & ' ( $If( ) Q _ 4-@t$$Ifl400$  &04 la$IfX$$Ifl40$'04 la E F    t$$Ifl400$  &04 la$If     > @ T V X b d | ~  46JLNXZ  &(<>@JLTpzCJj Uj Uj Uj4 Uj UjH UjUmHnHujU jU3  < > f z | $Ift$$Ifl400$  &04 la YSSS$If$$Ifl4\0 $\ N 8 &&04 la&(*4\$Ift$$Ifl400 $\ ^  &04 la\^Y|S$If$$Ifl4\0 $\ N 8  &&04 la&Nh$Ifa$$Ifl40$'  &04 laNPRprtvxzec^ccccc$a$$$Ifl4\0$,   &04 la/ =!"h#$%tDText1tDText2tDText3tDText4tDText5tDText6tDText7tDText8tDText9vDText10xDhazard1Daddinfoadditional informationtDeCheck1tDeCheck2tDeCheck3tDeCheck4tDeCheck5tDeCheck6tDeCheck7vDText12vDText13vDText14vDText15vDText16vDText17vDText18 i0@0 Normal_HmH sH tH 4@4 Heading 1$@&5CJ0@0 Heading 2$@&CJ<A@< Default Paragraph Font,, Header  !, @, Footer  !==>-WX /CDEPdm !"#$%&'()Q_ EF  V ./'()89:;>-X00000000000000000000000000000000000000000000000000000000000000000000000000000000000000000@ z T< (  \Nz x /;AP\bmy_o  (8Vfx&,%=FFFFFFFFFFFtFtG G G G G G G FFFFFFFl,2$tt$c.m' =*@0(   B S  ?=Text1Text2Text3Text4Text5Text6Text7Text8Text9Text10hazard1addinfoCheck1Check2Check3Check4Check5Check6Check7Text12Text13Text14Text15Text16Text18Text17 0Qn`  )Wy> Bcp9g-&>)9:>)0QZ)9:>3333 /BPcm_p  (9Vgx-&(>Dept. of Labor and Industry.C:\WINDOWS\TEMP\AutoRecovery save of vosh7.asdDept. of Labor and Industry.C:\WINDOWS\TEMP\AutoRecovery save of vosh7.asdDept. of Labor and Industry.C:\WINDOWS\TEMP\AutoRecovery save of vosh7.asdDept. of Labor and IndustryC:\My Documents\Forms\vosh7.docDept. of Labor and Industry.C:\WINDOWS\TEMP\AutoRecovery save of vosh7.asdDept. of Labor and Industry.C:\WINDOWS\TEMP\AutoRecovery save of vosh7.asdDept. of Labor and IndustryC:\My Documents\Forms\vosh7.docDept. of Labor & IndustryO\\DLINOV1\VOL1\HOME\NCA\My Documents\Programs Forms\Heatlh Compliance\vosh7.docDept. of Labor & IndustryO\\DLINOV1\VOL1\HOME\NCA\My Documents\Programs Forms\Heatlh Compliance\vosh7.dotNenette Alfonte3E:\test website\vosh_compliance\pdf forms\vosh7.dot /CDEPdm()_EF ./'()9:>@PxL=pppp@p pUnknownGzTimes New Roman5Symbol3& zArial"qh#aLbSf  #20d?2)Virginia Department of Labor and IndustryDept. of Labor and IndustryNenette AlfonteOh+'0 0< X d p |*Virginia Department of Labor and IndustryrdirgDept. of Labor and Industryeptvosh7ofNenette Alfonte3neMicrosoft Word 9.0I@G@@UM^@Pj ՜.+,0( hp  Commonwealth of Virginian ? *Virginia Department of Labor and Industry Title !"#$%&')*+,-./012345679:;<=>?ABCDEFGJRoot Entry FL}LData  1Table(LWordDocument>SummaryInformation(8DocumentSummaryInformation8@CompObjjObjectPoolL}L}  FMicrosoft Word Document MSWordDocWord.Document.89q