Your Name
We cannot investigate specific infractions if we don't have your information.
First Name
Last Name
Your Email
We cannot investigate specific infractions if we don't have your information.
Name of your employer
(Required)
The organization you work for as it appears on official documents.
Employer Address
(Required)
Address Line 1
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Employer Identification Number (EIN)
A 9-digit number. Do not include hyphens.
Human Resources Contact
First Name
Last Name
Human Resources Email
Human Resources/Employer Phone Number
(Required)
Did your employer notify you of Massachusetts Paid Family and Medical Leave through a notification or acknowledgement letter in your primary language?
(Required)
For example, during employee orientation, the employee handbook, or an email.
Yes
No
Is your employer's PFML poster displayed somewhere you can see it?
(Required)
For example, in an email, in your breakroom, or on the Human Resources website.
Yes
No