Agricultural Labor Compliance Declaration Form
Submit your labor practices, worker protections, and compliance follow-up details.
Agricultural Employer or Operation Name
*
Primary Contact
*
First Name
Last Name
Contact Email
*
example@example.com
Type of Agricultural Operation
*
Please Select
Crop production
Livestock or animal production
Nursery or greenhouse
Mixed agricultural operation
Other
Approximate Number of Workers
*
Labor Practices in Place
*
Written or clearly communicated work terms
Accurate work-hour and wage records
A process for workers to raise concerns
Regular review of labor practices
Other
Worker Protections in Place
*
Workers receive relevant safety information and training
Workers have access to appropriate protective equipment
Work areas and equipment are maintained safely
Workers can report hazards or concerns without retaliation
Other
Compliance Follow-Up Status
*
No follow-up currently needed
Follow-up actions are in progress
Follow-up assistance is needed
Declaration: I declare that the information provided in this Agricultural Labor Compliance Declaration Form is accurate to the best of my knowledge.
*
Submit Declaration
Submit Declaration
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