OSHA-7 OSHA Form 7 Chinese

English	Chinese
OSHA Online Complaint Form	OSHA在线举报表
Notice of Alleged Safety or Health Hazards	安全或健康危害通知
EMERGENCY NOTICE	紧急通知
Do Not Report an Emergency Using this Form or Email!	如有紧急情况，请勿使用本表格或电子邮件举报！
To report an emergency, fatality, or imminent life threatening situation please contact our toll free number immediately:	如需报告紧急事件、死亡情况或即将发生的危害生命安全的情况，请立即拨打我们的免费电话：
1-800-321-OSHA (6742)	1-800-321-OSHA (6742)
TTY 1-877-889-5627	TTY 1-877-889-5627
Please fill out sections 1 through 19, but READ THIS FIRST. Items noted with an asterisk (*) are required in order to accept your submission.	请先阅读此处，随后填写1到19部分。带星号（*）的内容为必填项，否则将无法提交表格。
*1. Establishment Name	*1.单位名称
Note: In order for OSHA to fully process your complaint, complete and accurate information about the worksite is necessary.	注：为便于OSHA（职业安全与健康管理局）处理您的举报，完整、准确的工作场所信息非常重要。
*2. Site Street:	*2.场所街道：
*3. Site City:	*3.场所城市：
*4. Site State:	*4.场所所在州：
*5. Site Zip Code:	*5.场所邮编：
6. Mailing Address (if different):	6.邮寄地址（若不同）：
7. Management Official:	7.管理官员：
8. Telephone Number:	8.电话号码：
9. Type of Business:	9.业务类型：
*10. Hazard Description.	*10.危害描述。
Describe briefly the hazards(s) which you believe exist. Include the approximate number of employees exposed to or threatened by each hazard:	简单描述你认为存在的危害。注明每种危害所影响或威胁的雇员的大致数量：
*11. Hazard Location.	*11.危害位置。
Specify the particular building or worksite where the alleged violation exists:	注明违规行为所在的具体建筑或工作场所位置：
*12. This condition has been brought to the attention of: (Choose all that apply) □ Employer □ Other Government Agency (specify)	*12.这种情况已得到以下各方的注意：（选择适用的内容） □ 雇主 □ 其他政府机构（注明）
13. I am a(n): □ Former Employee □ Current Employee □ Federal Safety and Health Committee □ Representative of Employees □ Other: (specify)	13.我是： □ 前任雇员 □ 现任雇员 □ 联邦安全与健康委员会 □ 雇员代表 □ 其他。（注明）
The OSH Act gives complainants the right to request that their names not be revealed to their employer. Providing your name and address, will only allow OSHA staff to communicate with you regarding your complaint.	《工作安全和健康法》规定，举报人有权利要求不向雇主透露其姓名。提供您的姓名和地址后，OHSA员工不会因举报事件以外的原因联系您。
14. Please Indicate Your Desire: Do NOT reveal my name to my Employer My name may be revealed to the Employer	14.您是否希望透露自己的姓名： 不要向我的雇主透露我的姓名 可以向雇主透露我的姓名
*15. Complainant Name:	*15.举报人姓名：
This constitutes my electronic signature. (If this box is checked, this submission shall be considered as an authorized written signature.)	这是我的电子签名。 （如勾选此框，将视为文件已经过授权书面签名。）
*16. Complainant Telephone Number:	*16.举报人电话号码：
17. Complainant Mailing Address Street: City: Sate: ZIP Code:	17.举报人邮寄地址 街道： 城市： 州： 邮编：
*18. Complainant E-Mail Address:	*18.举报人邮寄地址：
19. If you are an authorized representative of employees affected by this complaint, please state the name of the organization that you represent and your title: Organization Name: Your Title:	19.如果你作为雇员的授权代表提出该举报，请注明你所代表的组织的名称以及你的职位： 组织名称： 你的职位
SEND	发送
Clear Form	清除表格
Punishment for Unlawful Statements	违法声明的处罚
Potential complainants also should keep in mind that it is unlawful to make any false statement, representation, or certification in any complaint. Violations can be punished under Section 17(g) of the OSH Act by a fine of not more than $10,000, or by imprisonment of not more than 6 months, or by both.	举报人应谨记，在任何举报中提供虚假的声明、陈述或证明均属违法行为。根据《工作安全和健康法》第17(g)部分规定，违者可处以10,000美元以下罚款或六个月以下监禁，或同时处以罚款和监禁。
Public reporting burden for this voluntary collection of information is estimated to vary from 15 to 25 minutes per response with an average of 17 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An Agency may not conduct or sponsor, and persons are not required to respond to the collection of information unless it displays a valid OMB Control Number. Send comment regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to the Directorate of Enforcement Programs, Department of Labor, Room N-3119, 200 Constitution Ave., NW, Washington, DC; 20210.	公众填写此信息收集表的时间预计为每份15到25分钟，平均时间为17分钟，包括查看说明、查询现有资料、收集和维护所需资料、填写并检查表格信息所需的时间。机构不得开展或发起信息收集活动。除非信息收集表具有有效的OMB控制编号，否则公众没有对其作出回应的义务。有关预计填写时间及该信息收集表的任何其他意见，包括如何缩短填写时间的建议等，请寄往劳工部实施方案理事会（Directorate of Enforcement Programs, Department of Labor, Room N-3119, 200 Constitution Ave., NW, Washington, DC; 20210）。
OMB Approval# 1218-0064; Expires: 08-31-2017	OMB批准号1218-0064；到期日：08-31-2017
DO NOT SEND THE COMPLETED FORM TO THIS OFFICE.	请勿将完成填写的表格寄到该办公室。