What is DA Form 4755? It is the Department of the Army form titled EMPLOYEE REPORT OF ALLEGED UNSAFE OR UNHEALTHFUL WORKING CONDITIONS, and it exists so that you can employee report of alleged unsafe or unhealthful working conditions. That single line covers most of what people arrive looking for. The rest of this page fills in the details.
Am I looking at the right edition? The copy here carries the date 10/01/1978 and the status ACTIVE. Forms in the DA series are identified by edition date rather than by revision number, so that date is what you compare against.
Who fills it out, and how long does it take? The individual named in the entries fills it, or a records clerk fills it on that person's behalf. Length is 1 page(s) with about 102 entry fields, which is the honest measure of the work involved. Who owns the form and when it is raised comes from DAS and PAM 385-10 respectively.
What the form asks for
- ACTIVITY
- CHARGE
- ContentArea1
- DATE
- DISCUSS
- EMPLOY_A
- EMPL_REP
- HAZARD
- NO_REVEA
- OPERATIO
- OTHER
- PLACE
- Page1
- R100
- R101
- R102
- R103
- R104
- R105
- R106
- R107
- R108
- R109
- R110
Download the form
What can I download here? The formats available are PDF, XFDL. Each one reproduces the identical official layout. What separates them is the method of entry, nothing on the page itself.
Fillable or printable — which do I want? Fillable, if there is a keyboard involved: the boxes are interactive objects that store text. Printable, if there is a pen involved: the boxes are just lines on paper. Nothing else distinguishes them.
Which application should I use? Reading takes nothing beyond a browser. Filling takes a proper pdf reader, since browser viewers vary in whether they retain what you type — verify with a single field and a save before you fill the whole form. What is xfdl? The IBM Lotus Forms format used inside Army systems. It requires the Lotus Forms Viewer; nothing else opens it.
Do I have to sign up? No. Every format is free, no account is involved, and the file is distributed unmodified.
Where do you start? At the top of the page, with the identifying entries: name as your official records spell it, identification number, unit or organisation, date of preparation. Why first? Because those entries are what the form is filed and searched under later, and a record indexed on a misspelled name is a record nobody retrieves.
How should you work through the entry fields? With the tab key. It follows the order the form was constructed in, which is usually the order the page reads, so nothing gets passed over. Do check boxes work the same way? They are clicked rather than tabbed into. In an exclusive group, a second click elsewhere clears your first choice, as intended.
Can a field hold a long answer? Not if it is sized for one line — there is no wrap, and the excess prints missing while remaining visible as you type. So where does the extra text belong? In the remarks area or a continuation sheet. Should you skip fields that are irrelevant to your case? No. Mark them accordingly, because an empty field reads as an oversight rather than an answer.
Where does the signature belong in the sequence? At the very end, by hand or by an accepted electronic means. An unsigned form is a draft regardless of how full it is. Are countersignatures needed? Where the form provides for them — reviewing official, approving authority, witness — taken in printed order and dated on the day applied. What should you check before releasing it? Empty mandatory fields, digit transposition in identification numbers, day-month inversion in dates, and residue from an old copy used in place of a blank one.
What is the Privacy Act statement on the page? A notice appearing wherever personal information is collected, setting out the authority for the collection, the purpose, the routine uses, and whether your disclosure is mandatory or voluntary. When should you read it? At the point you reach it, before entering the details it covers. And afterwards? Your completed copy holds personal data and is stored and transmitted under the rules that apply to such records.
Where do you send it? To the destination the prescribing directive names, which may be a specific office, the unit administrative channel, or the individual's file. Is a copy worth keeping? Always, and taken before submission. How long does the receiving office keep it? For the period the records schedule for the series prescribes, regardless of local custom.
What if this form is not the only one you need? Search by series and number. Within the DA series, forms under the same proponent or the same prescribing directive tend to be required as a set, and anything named on the face of one normally accompanies it. Are continuations part of that? They are, along with covers and transmittals, and all of them are collected in advance rather than after a query.
Why do editions change? Because the proponent revises the content, and the edition date printed on the page marks the result. How do you tell whether a stored copy is still current? Compare its printed date against the edition in force before you use it again. Does a new edition invalidate what you already filed? No. Records executed under a superseded edition stand as they are.
What exactly is this site? A place to download reproductions of published Department of the Army documents. Is it part of the Department of the Army? No — it is independent, issues no forms of its own, and has no authority over any of them. Can it tell you whether your completed form will be accepted? It cannot, and nothing written here is legal advice. Who answers the real questions? DAS or the administrative office servicing your unit, on any question of entry, requirement or eligibility.
Questions and answers
- What is DA Form 4755?
- EMPLOYEE REPORT OF ALLEGED UNSAFE OR UNHEALTHFUL WORKING CONDITIONS
- Which edition is current?
- 10/01/1978
- Who is responsible for this form?
- DAS
- In which formats can it be downloaded?
- PDF, XFDL, PDF