State, County, and Local Governments Employee Complaint Form

If you are an employee of a state agency, county government, a municipality, or any division thereof, a water district, sewer district, school district or any other quasi-municipal agency and want to report a safety or health violation, or believes the employer has discriminated or retaliated against you for reporting an unsafe condition, please fill out the online-form below, or download and fill out the paper form.

If you have any questions about filing a complaint, completing this form, or have a wage & hour concern or complaint please call 207-623-7900.

1. Please Check one: I am an Employee



4.Your Phone:

5. Your Address:


7.Your Employer:




11. Does the alleged violation threaten imminent death or serious harm? Yes

12. Has the condition been discussed with your employer and no action taken?

13. Can we use your name: DO NOT reveal my name You can use my name