Legislative branch employees have rights under the CAA ensuring that their workplace is free from health and safety hazards. If there is a suspected health or safety hazard on the Capitol campus or in a district office, an employee may complete the request form and submit it to the OCWR.

Click here to download the request form.

Forms should be mailed, hand-delivered or faxed to the OCWR. Fax number: (202) 426-1913. Forms also can also be emailed to



Members of the public (including legislative branch employees and constituents) have rights under the CAA ensuring that the Capitol Hill complex and district and state offices are accessible to individuals with disabilities in the provision of public services and accommodations established by Titles II and III of the ADA. To request an ADA inspection or to file a charge alleging a violation of the ADA, please use this form. Please drop off completed form to the Office of Congressional Workplace Rights or fax to: (202) 426-1913. If you would like to email the form, click here and email the completed form to



The following forms are provided to assist a covered employee in pursuing a claim of a violation of sections 201 through 207 of the Congressional Accountability Act (CAA) under the Office of Congressional Workplace Rights' Administrative Dispute Resolution process. These have been updated to reflect the changes of the CAA Reform Act effective June 19, 2019. 

Once these forms are completed, please print, sign, scan and e-mail the completed form to

Request for Mediation

Notice of Designation of Representative

Claim Form

Amended Claim Form

Filing and Submission:

This form must be filed with the OCWR prior to the expiration of the 180-day period which begins on the date of the alleged violation of the CAA. The OCWR will not accept a Claim Form after the applicable deadline. Filing this form initiates formal proceedings on your claim(s) alleging that the CAA has been violated. Please be advised that immediately after you submit your claim form, a copy will be provided to your employing office.

All claim forms must be either e-filed (, emailed (, faxed (202-426-1913), or hand-delivered to: John Adams Building, 110 Second Street, SE, Room LA-200, Washington, DC 20540-1999.



Impasse Form 

Representation Petition 

Please click this form if you want to file a petition concerning labor representation.

Unfair Labor Practice Charge 

The Section 220 of the CAA prohibits Unfair Labor Practices (“ULP”) as enumerated at 5 U.S.C. § 7116.  If a legislative branch employee, union or employing office believes that a ULP has occurred, the aggrieved party may file a ULP Charge with the OCWR General Counsel, using the appropriate form below.  The OCWR General Counsel is responsible for investigating and prosecuting meritorious ULP Charges consistent with 5 U.S.C. § 7118 and Part 2423 of the Substantive Labor Management Relations Regulations.  Note that an original and 1 copy of a ULP Charge must be filed with the OCWR within 6 months of the ULP’s occurrence in order to be considered timely filed. 

ULP Charge Against an Employing Office 

ULP Charge Against a Labor Organization



Directory of Attorneys

Please note: House employees may also contact the Office of Employee Advocacy (OOEA) at 202-225-8800 to request free representation.



   Certification of Health Care Provider for Employee’s Serious Health Condition

   Certification of Health Care Provider for Family Member’s Serious Health Condition

   Notice of Eligibility Rights and Responsibilities

   Designation Notice

   Certification of Qualifying Exigency for Military Family Leave

   Certification for Serious Injury or Illness of a Current Servicemember – for Military Family Leave

   Certification for Serious Injury or Illness of a Veteran for Military Caregiver Leave



   Office Workspace Ergonomic Self-Evaluation

   Request for Ergonomic Evaluation