The California RH 1027 form is designed to report violations of radiation control regulations or unsafe conditions related to radiation sources. Employees, their representatives, or employers can use this form to notify the California Department of Public Health about safety concerns in the workplace.
The form can be submitted by:
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An employee who is directly involved.
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A representative of the employee.
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An employer of the involved employee.
After completing and signing the form, mail it to the following address:
California Department of Public Health, Radiologic Health Branch, MS 7610, Compliance Unit, P.O. Box 997414, Sacramento, CA 95899-7414.
The form requires several details, including:
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Your name and contact information.
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The name and address of the employer.
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A description of the violation or unsafe condition.
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Any relevant regulation sections that have been violated.
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Information on whether the issue has been reported to any other government agency.
Once the form is submitted, the California Department of Public Health will review the complaint. They may conduct an investigation based on the information provided. You will be notified of any actions taken regarding your complaint.
Can I remain anonymous when filing a complaint?
You have the option to disclose your name or remain anonymous. However, if you choose to remain anonymous, it may limit the Department's ability to follow up on the complaint.
What if the violation has already been reported?
If the violation has been reported to another government agency, you should still complete the RH 1027 form. Provide details about the other agency and any actions taken so far. This information can help the Department address the issue more effectively.