DLSE forms - Retaliation/Discrimination

The forms on this server are replicas of the official DLSE forms. You will need Adobe Acrobat Reader to view or print the forms. To obtain a form by mail, contact your local DLSE office.

Forms (related publications are listed separately below)

Retaliation/Discrimination Complaint
- DLSE Form RCI 1 - English (RCI 1) (Rev. 11/2012)
- DLSE Form RCI 1 - Spanish (Rev.11/2012)
- DLSE Form RCI 1 - Chinese (Rev. 11/2012)
- DLSE Form RCI 1 - Korean (Rev. 11/2012)
- DLSE Form RCI 1 - Vietnamese (Rev. 11/2012)
- DLSE Form RCI 1 - Tagalog (Rev.11/2012)
Equal Pay Act Complaint
- Form (EPA -1)

Note: If your printer has a problem printing the form, try the "Fit to page" box in the Acrobat Adobe Reader's print function.

Publications (related forms are listed separately above)

Retaliation and Discrimination Complaints - A summary of procedures (English) (Rev. 09/2020) (html)
Retaliation and discrimination complaints - A summary of procedures (Spanish) (Rev. 09/2020) (html)

Participation without retaliation
- English (Rev. 02/2013)
- Spanish (Rev. 02/2013)
- Korean (Rev. 02/2013)

Note: Additional forms and publications may be added in the future.

Office Name	Topic	Phone Numbers
Cal/OSHA	Workplace Safety and Health	833-579-0927
Labor Commissioner's Office	Wages, breaks, retaliation and labor laws	833-526-4636
Division of Workers' Compensation	Benefits for work-related injuries and illnesses	1-800-736-7401
Office of the Director	Any other topic related to the Department of Industrial Relations	844-522-6734

DLSE forms - Retaliation/Discrimination

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