BUREAU OF LABOR LAW COMPLIANCE
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:
*
---Select---
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
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:
*
---Select---
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Zip Code:
*
County:
---Select---
None
Adams
Allegheny
Armstrong
Beaver
Bedford
Berks
Blair
Bradford
Bucks
Butler
Cambria
Cameron
Carbon
Centre
Chester
Clarion
Clearfield
Clinton
Columbia
Crawford
Cumberland
Dauphin
Delaware
Elk
Erie
Fayette
Forest
Franklin
Fulton
Greene
Huntingdon
Indiana
Jefferson
Juniata
Lackawanna
Lancaster
Lawrence
Lebanon
Lehigh
Luzerne
Lycoming
McKean
Mercer
Mifflin
Monroe
Montgomery
Montour
Northampton
Northumberland
Perry
Philadelphia
Pike
Potter
Schuylkill
Snyder
Somerset
Sullivan
Susquehanna
Tioga
Union
Venango
Warren
Washington
Wayne
Westmoreland
Wyoming
York
Out of State
Do you wish to remain anonymous?
YES
NO
Violations
1. Are minors employed under the age of 14 years old?
*
YES
NO
If Yes, please explain:
*
2. Are minors employed with working papers officially called Employment Certificates?
:
*
YES
NO
3. Are minors employed more than 8 hours a day?
*
YES
NO
4. Are minors employed in what may be excessive hours per week?
*
YES
NO
If Yes, please explain:
*
5. Are minors employed under age of 18 years old?
*
YES
NO
6. Are minors employed in a prohibited occupation?
*
YES
NO
If Yes, please explain:
*
7. Are minors employed more than 5 hours without 30 min. 'Break'?
*
YES
NO
If Yes, please explain:
*
8. Are minors employed late at night; either during school or summer vacation?
*
YES
NO
If Yes, please explain:
:
*
9. Are minors employed during very early or odd hours of the morning?
*
YES
NO
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.
BUREAU OF LABOR LAW COMPLIANCE
651 BOAS STREET, ROOM 1301
HARRISBURG PA 17121
Phone: (800) 932-0665 Fax: (717) 787-0517
EMAIL: