Safety Complaint Form


This form is for reporting a dangerous condition involving an amusement ride, boiler, elevator, pressure vessel, escalator, or related equipment located in Iowa. Owners and operators are required to report an incident such as an injury, fire, or explosion using a separate report form.

You may also download the form here.

The form can also be submitted via fax to 515-242-5076, or the form can be mailed to:

Division of Labor
150 Des Moines Street
Des Moines, IA 50309-1836


Complaint Details

Type of equipment?

Owner Name

Owner's name?

Equipment Location

Location where the equipment is located?

Contact Information

Your name?
Your address?
Your phone?
more items


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