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Paid Leave for All Workers Act Complaint Form

Leave Rights Complaint Form

PAID LEAVE COMPLAINT: 

-> Do you work in Chicago? Click Here

-> Do you work in Cook County? Click Here

Please use this form to file a complaint if you believe you were wrongfully denied leave under the:

  • Paid Leave for All Workers Act. This can include improper accrual, use, or rollover of paid time off, as well as records violations, retaliation, or no public notice. 
  • Child Bereavement Leave Act
  • Family Bereavement Leave Act
  • Employee Sick Leave Act

A complaint form in PDF format is available. Download to your computer, fill-in, and save the completed form. Email to DOL.PaidLeave@illinois.gov.

Employee Information

Employer Information

Employment information

Complaint Reason Details

Attachments

Please attach any of the following documents if you have them:  

  • Copy of your last paycheck
  • Copy of your latest W2
  • Copies of wage records or paystubs for relevant time period
  • Relevant pages from Employee Handbook or Manual
  • Any communications between you and your employer on this request
  • Other relevant documents

    Demographic information

    IDOL asks for this voluntary information in order to learn more about the people who file complaints with us. Any information you provide will not be shared or used in relation to your complaint.

    I understand that in general the public has the right, under FOIA, to request most information kept as part of any public record, however, the IDOL, will endeavor to keep the confidentiality of a complainant or witness to the maximum extent allowable by law.

    I hereby certify that the application, including attachments, is true and accurate to the best of my knowledge.