United States Department of Workplace Activities

Complete all required fields below. A case identification number will be issued upon submission. All fields marked * are required.

Your Information

Full Name *

Email Address *

Workplace / Employer *

Date of Incident *

Subject of Report

Coworker Full Name *

Coworker Department (optional)

Incident Description

Description of Conduct *

By submitting this form you acknowledge that your submission will be retained indefinitely by DOWPA and may be shared with any party the Department deems relevant, including the subject of this report, their supervisors, and other federal agencies. DOWPA does not guarantee investigation, action, or resolution. Submission of a false or misleading report may itself constitute a DOWPA policy violation.

Report a Coworker