Section Lab 904.01 - Complaint Form Any person defined as an employee under RSA 275-E:1, I or a public employee defined under RSA 275-E:1, III filing a whistleblowers' complaint under the provisions of RSA 275-E:4 shall supply the following on the "Whistleblowers' Complaint Form" provided by the department of labor:
(a) The complainant's name;(b) The complainant's mailing address and telephone number;(c) The name and mailing address of the employer/company that the complaint is filed against;(d) The name and telephone number of the employer representative to whom the complaint should be directed;(e) A description of the complaint, describing the alleged violation of rights under RSA 275-E:2 or RSA 275-E:3;(f) If applicable, the date of the discharge;(g) A description of the alleged discrimination, retaliation or threat made;(h) An indication whether the employer has a grievance procedure available;(i) If there was a grievance procedure available, an indication of whether the complainant followed the employer's procedure before filing the complaint;(j) The specific relief the complainant is seeking by filing the complaint;(k) In addition to (a) - (j) above, the following information if the complaint is filed under RSA 275-E:2 (a), I for reporting or causing to be reported an alleged violation: (1) The alleged violation of the law or rule that was reported;(2) The name and title of the person to whom the alleged violation of law or rule was reported;(3) The name of the person or persons who allegedly violated the law or rule;(4) The date the alleged violation of law or rule occurred;(5) How the alleged violation of law or rule occurred;(6) The date the alleged violation of the law or rule was reported;(7) How long the employer was given to correct the alleged violation before reporting it; and(8) If the alleged violation was not reported to the employer, the reason why it was not.(l) In addition to (a) - (j) above, the following information if the complaint is filed under RSA 275-E:2 (b), I: (1) The alleged illegal activity that the complainant objected to or refused to participate in;(2) The name and title of the person or persons who asked the complainant to participate in the alleged illegal activity; and(3) The date on which the complainant objected or refused to participate in the alleged illegal activity.(m) In addition to (a) - (j) above, the following information if the complaint is filed under RSA 275-E:2 (c), I: (1) Whether or not the complainant participated in an investigation, hearing, inquiry, or court action;(2) The specific action, whether investigation, hearing, inquiry, or court action in which the complainant participated;(3) The date or dates upon which the complainant participated in an investigation, hearing, inquiry, or court action; and(4) The name of the agency or court where the complainant's participation in an investigation, hearing, inquiry, or court action, took place.(n) In addition to (a) - (j) above, the following information if the complaint is filed under RSA 275-E:3 for refusal to execute an illegal directive: (1) The alleged illegal directive ordered by the employer;(2) The name and title of the person or persons who ordered the alleged illegal directive; and(3) The date the alleged illegal directive was ordered.(o) In addition to (a) - (j) above, the following information if the complaint is filed by a public employee under RSA 275-E:9:(1) The date on which the public employee first reported the alleged violation of fraud, waste, or abuse in the expenditure of public funds, or in relation to programs involving procurement of supplies, services or construction by a governmental entity in the state to the department of labor;(2) The case number provided to the complainant when the above complaint was filed with the department of labor; and(3) For complaints filed for violation of RSA 275-E:2, for the gross mismanagement or waste of public funds, property, or manpower, or for evidence of an abuse of authority or a danger to the public health and safety, the complainant shall provide the information on the form as described in (k), above.(p) The signature and date of the complainant certifying that the complaint is a truthful statement of the facts involved.N.H. Admin. Code § Lab 904.01
#7351, eff 8-24-00, EXPIRED: 8-24-08
New. #9257, eff 9-11-08; ss by #10522, eff 2-15-14
Amended by Number 37, Filed September 14, 2023, Proposed by #13731, Effective 8/25/2023, Expires 8/25/2033.