Reprisal Complaint

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  • Reprisal is any action or threat of action by an employer or union that negatively affects a worker’s employment circumstances.
  • Workers are protected from reprisal when performing protected activities listed under section 53 of the Workers’ Safety and Compensation Act (the Act).
  • Workers must elect to either:
    1. File a complaint in accordance with the dispute resolution process set out in their collective agreement, if there is one; or
    2. File a written complaint with the board.
  • Reprisal Complaints filed with the board must be submitted within 21 days of the date of the alleged reprisal.

    • To make a complaint regarding a health and safety concern at a workplace, please contact the Workplace Health and Safety Branch at 867-667-5450 or toll-free at 1-800-661-0443.

Worker Contact Information

What was the position you were working in during the period of the reprisal you are reporting?
Tell us the month and year you started with the employer involved in the reported reprisal.
Tell us what the status of your employment with the employer involved in the reported reprisal.
Tell us the day you last worked for the employer involved in the reported reprisal. If you are still working for this employer please enter todays date.

Employer Contact Information

What is the type of work that this business generally does?
What is the name of the person who managed or supervised you at the time of the reprisal you are reporting?

Workplace Address

“Workplace” means a building, site, project site, workshop, structure, vehicle or mobile equipment, or any other location where one or more workers perform or have performed work.
Provide the street address of where you performed work. If there is no street address, provide the best description.
What is the community of the workplace, or the community nearest to the workplace?
What is the postal code of the workplace?

Description of Events

Check each protected activities you took part in:

Select all that apply.

Signature, consent and declaration

This information is being collected for the purpose of administering and enforcing the Workers’ Safety and Compensation Act in compliance with the Access to Information and Protection of Privacy Act. If you have any questions about the collection of this information, please contact the board’s Privacy Officer at 401 Strickland St., Whitehorse, YK, Y1A 5N8 or call 867-667-5642 or 1-800-661-0443.
I acknowledge that electronic communication has inherent security risks, as do all forms of communication. Notwithstanding the inherent risks of electronic communication, I consent to the use of electronic methods to transmit and receive information, including confidential and personal information between the board and myself. This consent will remain in effect until written notice to revoke this authorization has been received by the board.
By signing and dating this form, I agree that I have read this Form and certify that the statements contained within are true, complete, and accurate to the best of my knowledge. I understand that:
  • 4.1 Providing false or misleading information is against the law and is an offence under the Act. The consequences for giving false or misleading information are administrative penalties or prosecution.

  • 4.2 A copy of this complaint will be fully disclosed to the employer named in section 2 above.

  • 4.3 I have not filed a complaint through my collective agreement about the reprisal reported on this form.

  • 4.4 Any changes to my Worker Information during the investigation will be emailed to the Workplace Health and Safety Branch at: [email protected]