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DOE F 440.2

This form is provided for use by any U.S. Department of Energy (DOE) contractor employee or representative thereof who (1) believes that a violation of a DOE safety regulation or DOE security regulation/policy has occurred and (2) requests that the DOE Office of Enforcement initiate an inspection or investigation into the violation. This form is not intended for use in filing complaints that do not involve a violation of DOE regulations. Please be advised that information in your request, except your name and other identifying information about you, if you have indicated below that your request is to remain anonymous or confidential, will be provided to the appropriate DOE Headquarters and field office organizations as their cooperation will be needed in evaluating the request. DO NOT use this form to report an emergency or immediately life-threatening condition. DO NOT include any classified information.