OLS Deactivation · Office of Labor Standards

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Compliance

What date did your deactivation take effect?

Company that deactivated you?

Company Other (please specify)

During the past 180 days, when you worked on the app, was at least 25% of the work in Seattle?

NoYes

Was your deactivation because of something you were accused of doing while in Seattle?

NoYes

Deactivation Notice

Records and Evidence

Did the company provide the records or evidence it relied on for the decision?

NoYes

Does the company have a written deactivation policy you can access, stating what conduct can lead to deactivation?

NoYes

Appeal

Did you give the company a written appeal to your deactivation?

NoYes

Did the company respond to your appeal within 14 days?

NoYes

Is the company’s process for appealing your deactivation available to you?

NoYes

Did the company provide a reason for the delay and a date when it would respond to your appeal?

NoYes

Notification of Rights

Did the company provide you with written notice that describes your rights under Seattle’s App-Based Worker Deactivation Rights Ordinance?

NoYes

Did you ask or inform the company about your rights related to deactivation or Seattle’s law?

NoYes

Do you believe you experienced retaliation for asking or informing the company about rights related to deactivation or Seattle’s law?

NoYes

Contact Information

First Name

Last Name

Has Attachments

NoYes

Telephone

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App-Based Worker Deactivation Intake Form

Compliance

Deactivation Notice

Records and Evidence

Appeal

Notification of Rights

Contact Information