DA Form 4755 – Employee Report of Alleged Unsafe Working Conditions

DA Form 4755 PDF Details

The DA Form 4755 is a formal U.S. Army document that gives employees a structured way to report alleged unsafe or unhealthful working conditions to management and the local Safety Office. The form is mandated by Army Regulation 385-10 and backed by the Office of the Inspector General.

Who Can File a DA 4755 Form

Any Army employee or authorized representative may file this report. AR 385-10 prohibits retaliation against anyone who files in good faith. Both immediate dangers and long-term health hazards qualify for reporting.

What the Form Documents

The DA 4755 form captures the specific nature of the hazard, the number of employees exposed, any applicable OSHA standard violations, and prior efforts to address the issue through union grievances or direct employer discussions.

How to Submit the Completed Form

Completed forms are submitted to the local Safety Office for the installation or worksite. The office is required to investigate and provide a written response. If the hazard poses an immediate danger, the report should be flagged as urgent.

Related Workplace Safety Forms

Workplace safety reporting often requires multiple documents. You may also need to complete an OSHA workplace inspection checklist, a first injury report, or a workers compensation injury report.