Download the form
DA Form 4755 exists to employee report of alleged unsafe or unhealthful working conditions — that is the short version. Title of record: EMPLOYEE REPORT OF ALLEGED UNSAFE OR UNHEALTHFUL WORKING CONDITIONS. The page covers the download, the entries and the disposition, nothing else. Current here: edition 10/01/1978, status ACTIVE, 1 page(s), near 102 fields.
Authority sits in two places. DAS owns the form, PAM 385-10 says when it is raised and where it goes. Routine cases need neither read in full — the page itself carries the sequence. The entries are completed by their subject or by unit administrative staff working from what that person supplies.
PDF, XFDL are available and the decision takes one second. Type your entries: fillable pdf. Write them: printable pdf. The published layout is common to both, so the format governs your method and nothing more.
A standalone reader is the safe choice for fillable work. Browser viewers vary in whether entered data survives the session, and there is no warning when it does not; a one-field save test settles it in seconds. Xfdl means IBM Lotus Forms. The Lotus Forms Viewer opens it; pdf readers and word processors do not.
Nothing is charged and no sign-up applies. Files are served as published, without changes to the page image.
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
The heading entries carry more weight than the body. Name spelled as in official records, identification number, organisation, date prepared. Retrieval runs on those values, so a transposed digit or a casual spelling costs someone a file search. Fill them before anything else.
Move between fields with tab; the build-time order follows the page and misses nothing. Click check boxes and option buttons, and expect an exclusive group to release the old choice when you set a new one. The trap is field width. Single-line fields do not wrap, so an overlong entry displays complete on screen and prints cut at the margin — put it in remarks or on a continuation instead. Mark inapplicable fields rather than leaving them blank, since an empty box carries no information about whether the question was read.
Sign last. An unsigned form is a draft whatever else is on it, and additional signatures — reviewer, approver, witness — follow printed block order with each signer dating the day they sign, not the day of preparation. Four faults account for most returns: a blank mandatory field, transposed digits in an identification number, day and month reversed in a date, and leftover entries in a working copy reused instead of a fresh blank. Read the form once from the top before releasing it.
Privacy Act statement first, personal entries second. The notice covers who is authorised to collect, why, who else routinely sees it, and whether you must answer. After completion the file carries personal data and is stored and sent under the corresponding safeguards.
The prescribing directive names the destination; office custom does not. Depending on the case that means a specific office, the unit administrative channel, or the personal record. Keep a copy first, because the original does not come back. Retention runs on the applicable records schedule.
Companion documents come from the same series and number scheme. Within the DA series, a shared proponent or a shared directive usually means shared use, and a form cited on the face of another accompanies it. Gather the whole package first — continuation sheets, cover sheets, transmittals.
Check the edition date before reusing a saved copy. Revisions come from the proponent without notice to you, and the printed date is the only version marker on the page. Already-submitted records under a superseded edition stand as filed; the change does not run backwards.
These are reproductions of published Department of the Army documents, offered for download. The site is independent, connected to nothing official, and issues no forms of its own. Nothing here is legal advice and no statement is made about acceptance by any office. Questions about an entry, a requirement or eligibility go to DAS or your servicing administrative office.
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