CASE DISPOSITION
COMPLAINT WITHDRAWAL REQUEST
This form is provided for the assistance of any complainant and is not intended to constitute the exclusive means by which a withdrawal may be registered with the U.S.
Department of Labor.
The undersigned complainant wishes to withdraw the discrimination complaint, filed under Section 11(c) of the Occupational Safety and Health Act, Case Number 1-2345-02-001.
This withdrawal request is submitted voluntarily by the undersigned.
I understand that I have the right to a determination by the U.S. Department of Labor, subject to appeal, and I waive that right. __________
(Initials)
_________________________________________
(Complainant’s Signature)
_________________________________________
(Typed or Printed Name)
_______________________
(Date)
Withdrawal Request Received By: Withdrawal Request Approved By:
____________________________________ __________________________________
Investigator Date Regional Supervisor Date
4-11
Sample Oral Withdrawal Confirmation Letter
A confirmation letter of this type must be sent to a complainant who has orally requested to withdraw a complaint.
Certified Mail #[1234 5678 9012 3456 7890]
[date]
Mr. U. R. Complainant Street Address
City, State ZIP
Re: ABC Company/Complainant/Case No. 1-2345-02-001
Dear Mr. Complainant:
This confirms our conversation on [date], in which you advised me that you wished to withdraw your complaint in the above-referenced matter. As we discussed, by
withdrawing your complaint, you are waiving your right to appeal OSHA’s determination.
I will be submitting your file to my supervisor with a recommendation that your withdrawal request be approved and that this matter be closed. Should you have any questions, feel free to contact me.
Sincerely,
Name Investigator
U.S. Department of Labor - OSHA Street Address
City, State ZIP (123) 456-7890
Sample Withdrawal Approval Letter (for either oral or written withdrawals)
A letter of this type must be sent to the complainant approving the oral or written withdrawal of a complaint.
Certified Mail #[1234 5678 9012 3456 7890]
[date]
Mr. U. R. Complainant Street Address
City, State ZIP
Re: ABC Company/Complainant/Case No. 1-2345-02-001
Dear Mr. Complainant:
Your request to withdraw your complaint in the above-captioned matter has been approved. With this withdrawal, the case in this matter is closed.
If at any time in the future you have any questions or require any information regarding employee rights and employer responsibilities under the whistleblower protection statutes administered by OSHA, please feel free to contact this office
Sincerely,
Name
Regional Supervisory Investigator
cc: Respondent or Respondent’s representative
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Sample Postponement Letter to Respondent
Certified Mail #[1234 5678 9012 3456 7890]
[date]
ABC Company Street Address City, State ZIP
Re: ABC Company/Complainant/Case No. 1-2345-02-001
Dear Sir or Madam:
OSHA will agree to postpone its investigation of this matter pending private arbitration on condition that ABC Company (Respondent) (1) agrees to abide by all terms discussed in this letter, and (2) promptly signs and returns a signed copy of this letter to OSHA within ten business days of receiving this letter.
Respondent agrees that Complainant will be afforded a meaningful role in the selection of a neutral arbitrator, and that the arbitrator will have the authority and discretion to allow both Complainant and Respondent to conduct meaningful discovery. Respondent additionally agrees that Complainant may be represented by the attorney of his choosing throughout the arbitration process.
Respondent agrees that the arbitrator will be permitted to award the following remedies that would be available under [referenced statute], including [preliminary] reinstatement should the arbitrator find reasonable cause to believe that Respondent has violated the provisions of the Act, and reasonable attorneys’ fees should Complainant prevail.
Regarding the other costs and expenses of arbitration, Respondent agrees that it will bear the fees and costs associated with arbitration. Therefore, we believe that deferral to arbitration in this matter will not prove financially inaccessible to Complainant.
Finally, our agreement to defer to arbitration depends on Respondent’s waiver of any argument that arbitration would be untimely and our understanding that Respondent will promptly forward a copy of the arbitrator’s final written decision, including all findings of fact, to OSHA at the conclusion of the arbitration. At that time, OSHA will review the decision and findings of fact to determine whether to the arbitrator’s award should be given deference.
By signing below, Respondent agrees to abide by all terms discussed in this letter.
Respondent Date
Sincerely,
Regional Administrator
4-15
Sample Deferral Letter to Complainant
Letters of this type must be mailed to the parties when deferring to an arbitration decision that did not result in a settlement. If the arbitration did result in a settlement, an approval letter must be mailed to the parties following settlement review and
approval. See Chapter 6 for settlement approval procedures and a sample approval letter.
Certified Mail #[1234 5678 9012 3456 7890]
[date]
Complainant Street Address City, State ZIP
Re: ABC Company/Complainant/Case No. 1-2345-02-001
Dear [Mr./Ms. Complainant]:
On [date], the Occupational Safety and Health Administration (OSHA) received a copy of the arbitration decision reached regarding your complaint of retaliation filed on [date] against [Respondent’s name] (Respondent). We have reviewed the arbitrator’s written decision, which explained not only the outcome, but also the essential findings of fact and conclusions of law on which it was based. We find that that the arbitration proceedings dealt adequately with all factual issues raised in the above-referenced complaint, and that that the proceedings were fair, regular, and free of procedural infirmities. The outcome of the proceedings was neither palpably wrong nor repugnant to the purpose and policy of the Act. Accordingly, we hereby defer to the arbitrator’s decision. Consequently, this complaint is dismissed.
Appeal rights for OSHA 11(c), AHERA, ISCA
This case will be closed unless Complainant files an appeal by sending a letter to:
Director with a copy to:
Directorate of Enforcement Programs Regional Administrator
U.S. Department of Labor – OSHA U.S. Department of Labor – OSHA 200 Constitution Avenue, N.W. Street Address
Room N3610 City, State ZIP
Washington, D.C. 20210
To be considered, an appeal must be postmarked within 15 days of receipt of this letter.
If this finding is appealed, then the Directorate of Enforcement Programs will review the case file in order to ascertain whether the investigation dealt adequately with all factual issues and the investigation was conducted fairly and in accordance with applicable laws.
The outcome of an appeal is either the return of the case to the investigator for further investigation or denial of the appeal, after which the case is closed.
Appeal rights for STAA, ERA, CAA, CERCLA, FWPCA, SDWA, SWDA, TSCA, AIR21, SOX, PSIA, FRSA, NTSSA, CPSIA, ACA, CFPA, SPA, and FSMA
Respondent and Complainant have [30/60] days from the receipt of these Findings to file objections and to request a hearing before an Administrative Law Judge (ALJ). If no objections are filed, these Findings will become final and not subject to court review.
Objections must be filed in writing with:
Chief Administrative Law Judge Office of Administrative Law Judges U.S. Department of Labor
800 K Street NW, Suite 400 North Washington, D.C. 20001-8002 Telephone: (202) 693-7300 Fax: (202) 693-7365
With copies to:
[Respondent/Respondent’s Attorney]
Street Address City, State ZIP
Regional Administrator
U.S. Department of Labor – OSHA Street Address
City, State ZIP
In addition, please be advised that the U.S. Department of Labor generally does not represent any party in the hearing; rather, each party presents his or her own case. The hearing is an adversarial proceeding before an Administrative Law Judge (ALJ) in which the parties are allowed an opportunity to present their evidence de novo for the record.
The ALJ who conducts the hearing will issue a decision based on the evidence,
arguments, and testimony presented by the parties. Review of the ALJ’s decision may be sought from the Administrative Review Board, to which the Secretary of Labor has delegated responsibility for issuing final agency decisions under the [abbreviated name of statute]. A copy of this letter has been sent to the Chief Administrative Law Judge along
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with a copy of your complaint. The rules and procedures for the handling of [abbreviated name of statute] cases can be found in Title 29, Code of Federal Regulations Part
[24/1977/1978/1979/1980/1981/1982/1983], and may be obtained at www.whistleblowers.gov.
Sincerely,
Regional Administrator
cc: Respondent/Respondent’s attorney
Chief Administrative Law Judge, USDOL
[Primary enforcement agency, for statutes other than OSHA 11(c)]
SOL-OSH Division (STAA, SPA)
SOL-FLS Division (STAA, ERA, CAA, CERCLA, FWPCA, SDWA, SWDA, TSCA, AIR21, SOX, PSIA, FRSA, NTSSA, CPSIA, ACA, CFPA, and FSMA) DWPP