Compliance Tracking System (CTS)

Child Labor Act Complaint
Department of Labor & Industry - Bureau of Labor Law Compliance - Child Labor Act Complaint
This form is used for complaints under the Pennsylvania Child Labor Act of 2012, P.L. 1209, No. 151.
Claimant Information
First Name: * Daytime Telephone:
Initial: Evening Telephone:
Last Name: * FAX:
Address - Line 1: * E-Mail:
Address - Line 2:
City: *
State: *
Zip Code: *
Minor Information
Enter information relating to the involved Minor(s) (under the age of 18) in the area provided below.
Include Name, Address, Telephone Number, Age and/or Date of Birth (if known).
Employer Information
First Name of Contact Person: Company Name: *
Initial: Telephone: *
Last Name of Contact Person: Address - Line 1: *
First Name of Owner: Address - Line 2:
Initial: City: *
Last Name of Owner: * State: *
Zip Code: *
Do you wish to remain anonymous?
1. Are minors employed under the age of 14 years old? *
If Yes, please explain: *
2. Are minors employed with working papers officially called Employment Certificates?: *
3. Are minors employed more than 8 hours a day? *
4. Are minors employed in what may be excessive hours per week? *
If Yes, please explain: *
5. Are minors employed under age of 18 years old? *
6. Are minors employed in a prohibited occupation? *
If Yes, please explain: *
7. Are minors employed more than 5 hours without 30 min. 'Break'? *
If Yes, please explain: *
8. Are minors employed late at night; either during school or summer vacation? *
If Yes, please explain:: *
9. Are minors employed during very early or odd hours of the morning? *
If Yes, please explain: *
10. Please explain any additional needed information which may be helpful to complete the investigation of this complaint.
I hereby certify that to the best of my knowledge and behalf, the above information is a true statement of facts relating to the alleged Violation(s) of the Child Labor Act of the Commonwealth of Pennsylvania. The Bureau will contact you for any further information. Please notify the Bureau if there is a change of address or telephone by which to contact you.