Section 147 Reprisal Complaint Canada Labour Code Part II–Occupational Health and Safety

Important Information

Once you’ve filled out your form electronically, click the “Print to PDF” button at the end of this page. This will allow you to save a PDF version of your completed form to your desktop or mobile device. You must then submit the completed form through the E-FILING tab.

NOTE: If you have any questions about this form, please contact a Canada Industrial Relations Board officer at 1-800-575-9696.

The personal information provided in this form and any documents submitted with it are collected solely for the purpose of administering the Canada Labour Code and will be used to deal with and adjudicate matters that come before the Board. Parties that engage the Board’s services should be aware that this is a public process. The Board provides public access to case files and posts key decisions on its website. Board decisions may identify parties and witnesses by name and may include information about them that is relevant and necessary to the determination of the dispute.

READ THESE INSTRUCTIONS BEFORE YOU BEGIN

This form is to help you provide the information required for making a reprisal complaint pursuant to section 147 of the Canada Labour Code (the Code).

Section 147 of the Code prohibits an employer from retaliating against an employee for exercising his or her rights under Part II of the Code (Occupational Health and Safety). However, an employer may, after all the investigations and appeals under the Code have been exhausted, take disciplinary action against an employee who has wilfully abused those rights.

The Board will review your complaint having regard to the Code and the Board’s case law on section 147 complaints. It will consider all the material on file, including supporting documentation. Missing information or documents could lead to dismissal of the complaint or delays in its processing.

The Board has Industrial Relations Officers (IROs) involved in the processing of various cases throughout Canada. These IROs mediate cases, where appropriate. If a settlement is not reached during mediation, the officer may continue to assist the parties to achieve a voluntary settlement before the Board decides the matter. An IRO may contact you regarding mediation of your complaint

Complainant

Name (and any pronouns):

Address:

Telephone Number:

Email Address:

Name of Representative or Counsel:

Address:

Telephone Number:

Email Address:

It is your responsibility to advise the Board of any changes to your contact information.

Employer

Name of Company:

Address:

Telephone Number:

Email Address:

Name and position of employer representative:

Union (if applicable)

Name of Union:

Address:

Telephone Number:

Email Address:

Name and position of Union Representative:

III–Chronological Summary and Supporting Documents

Provide a chronology of the facts and events in support of your complaint. Include details such as the dates on which events occurred, the date you reported your health and safety concerns to the employer or took other actions. Include the names of the employer and health and safety officials involved and the names of any witnesses.

Please mention and attach any relevant documents that you are filing in support of your complaint. Number or assign a letter to each document (e.g., A, B, C). Examples of relevant documents include: documents related to the reported issue, workplace health and safety committee minutes, investigation report or the decision of the Minister, a Labour Canada officer or appeals officer. If certain documents are not in your possession, please mention this and explain why.

You may use additional pages if necessary. Please print clearly and number the pages.

IV–Timeliness

Section 133 of the Code requires that you file your complaint within 90 days after the date on which you first knew, or ought to have known, of the action or circumstances giving rise to your complaint.

On what date did you know of the disciplinary measures imposed or the action taken against you by the employer?

How did you find out?

Although sections 156(2) and 16(m.1) of the Code allow the Board to extend the 90-day time limit set out in section 133, the Board will only do so in exceptional circumstances. If you want the Board to consider extending the 90-day time limit, please explain the exceptional circumstances that you feel the Board should consider in deciding whether or not to exercise its discretion. Provide supporting documentation, if necessary.

V–Oral Hearing

There is no requirement for the Board to hold a hearing even if one is requested. Most complaints are decided without a hearing on the basis of the submissions and documents on file. Do you believe a hearing is necessary?

Yes

If yes, why do you believe that a hearing is necessary?

Where do you think the hearing should take place?

VI–Remedies

Under section 134 of the Code, the Board may require an employer to cease contravening the Code and/or rescind any disciplinary action taken.

What remedies are you seeking?

VII–Filing Your Complaint

The Board has an e-filing Web Portal (Portal) service, which allows you to file your Portable Document Format (PDF) documents in the Board’s centralized document filing system. You can access the Portal here. You can also file your complaint by mail. The Board’s contact information can be found on the Board’s website.

If you choose to file your document electronically using the Portal, do not forward a hard copy of the same document to the Board. The electronic version will be considered the original copy.

Signature

Date

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Section 147 Reprisal Complaint Canada Labour Code Part II–Occupational Health and Safety

Important Information

Employee Status:

Rights exercised pursuant to Part II of the Code:

If you are a unionized employee, please complete this section. Otherwise, continue to Section III.

How was your complaint handled? Please check all that apply. Please attach all relevant documents in your possession.

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Section 147 Reprisal Complaint Canada Labour Code Part II–Occupational Health and Safety

Important Information

Complainant

Employer

Union (if applicable)

I–General Information about the Complaint

Employee Status:

Rights exercised pursuant to Part II of the Code:

II–Disciplinary Action

If you are a unionized employee, please complete this section. Otherwise, continue to Section III.

How was your complaint handled? Please check all that apply. Please attach all relevant documents in your possession.

III–Chronological Summary and Supporting Documents

IV–Timeliness

V–Oral Hearing

VI–Remedies

VII–Filing Your Complaint