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COVID-19 Complaint Form

Former Governor Cuomo enacted a law that provides benefits - including sick leave, paid family leave, and disability benefits - to New York employees impacted by mandatory or precautionary orders of quarantine or isolation due to COVID-19. If your employer does not comply with this law, you have the right to file a complaint.


Complete this form to file a complaint.
1. title
(including area code)
This question requires a valid email address.
Business Name
5. Business Address
This question requires a valid number format.
(including area code)
(e.g. Retail, Restaurant, Barbershop/Salon, etc.)
8. Number of Employees (required) *This question is required.
9. Are you, or were you, under an order to quarantine or isolate given by a government entity? (required) *This question is required.
10. Did your employer tell you to continue to report to work? (required) *This question is required.
This question requires a valid date format of MM/DD/YYYY.
11. Have you been punished, threatened, or in any way experienced retaliation for asserting your rights to a safe workplace?