An employee who wishes to file a complaint under the Whistleblowers’ Protection Act must first complete the following Whistleblowers' Complaint Form , including filling out only the appropriate sections, either I, II, or III on the bottom half of the form.

Please sign the bottom of the form.  Make three copies and mail two (2) copies back to the Department of Labor at the following address: (Note: Keep the third copy for your records.)

NH Department of Labor
P.O. Box 2076
Concord, NH 03302-2076

If you have any questions or need assistance in completing this form, please contact the Department of Labor at 1-800-272-4353.

New Hampshire Administrative Rules Chapter LAB 900 Whistleblowers' Protection Act

Whistleblowers' Complaint Form

A Guide to the Whistleblowers' and Wage Claim Process

Whistleblowers' Mandatory Poster