MEAL BREAK VIOLATION COMPLAINT

COMPLAINT FOR FAILURE TO PROVIDE REQUIRED MEAL PERIODS

IMPORTANT NOTICE

Meal break laws vary significantly by state. There is no federal law requiring meal breaks for adult workers. This complaint template is primarily designed for states with meal break requirements, particularly California, which has the most comprehensive meal break protections.

States with Meal Break Laws Include:
- California (most comprehensive)
- Colorado
- Connecticut
- Delaware
- Illinois
- Kentucky
- Maine
- Maryland
- Massachusetts
- Minnesota
- Nebraska
- Nevada
- New Hampshire
- New York
- North Dakota
- Oregon
- Rhode Island
- Tennessee
- Washington
- West Virginia

PART 1: COMPLAINANT INFORMATION

Full Legal Name: _______________________________________________

Current Address:
- Street: _______________________________________________
- City: _________________________ State: _____ ZIP: ___________

Contact Information:
- Phone: _________________________
- Email: _________________________
- Preferred Contact Method: ☐ Phone ☐ Email ☐ Mail

PART 2: EMPLOYER INFORMATION

Employer Name: _______________________________________________

Doing Business As (DBA): _______________________________________________

Employer Address:
- Street: _______________________________________________
- City: _________________________ State: _____ ZIP: ___________

Employer Phone: _________________________

Type of Business/Industry: _______________________________________________

Supervisor/Manager Name: _______________________________________________

HR Contact: _______________________________________________

PART 3: EMPLOYMENT INFORMATION

Job Title: _______________________________________________

Date of Hire: _________________________

Date Employment Ended (if applicable): _________________________

Employment Status:
☐ Currently Employed
☐ Terminated
☐ Resigned
☐ Laid Off

Employment Type:
☐ Full-Time
☐ Part-Time
☐ Temporary/Seasonal

Employee Classification:
☐ Non-Exempt (Hourly)
☐ Non-Exempt (Salaried)
☐ Exempt (claimed by employer)

Hourly Rate/Salary: $__________ per __________

PART 4: WORK SCHEDULE INFORMATION

Typical Work Schedule:

Average Hours Per Day: _________________________

Average Hours Per Week: _________________________

How many days per week do you typically work more than:
- 5 hours: __________ days
- 6 hours: __________ days
- 10 hours: __________ days

PART 5: MEAL BREAK REQUIREMENTS (CALIFORNIA)

California Meal Period Requirements Under Labor Code § 512:

Timing Requirements:
- First meal period: No later than end of 5th hour of work
- Second meal period: No later than end of 10th hour of work

PART 6: TYPE OF MEAL BREAK VIOLATION (Check All That Apply)

Failure to Provide Meal Period

☐ No meal break provided when working more than 5 hours
☐ No second meal break provided when working more than 10 hours
☐ Meal break provided too late (after 5th hour for first; after 10th for second)

Shortened or Interrupted Meal Periods

☐ Meal breaks less than 30 minutes
☐ Meal breaks interrupted by work duties
☐ Required to remain "on call" during meal break
☐ Required to monitor phone/radio during break
☐ Required to stay on premises in a way that restricts break

Working During Meal Periods

☐ Told to work through meal break
☐ Given too much work to take full break
☐ Understaffed, unable to leave station
☐ Discouraged from taking breaks
☐ Penalized or criticized for taking breaks

On-Duty Meal Period Issues

☐ Required to work "on-duty" meal without proper agreement
☐ On-duty meal agreement not in writing
☐ Cannot revoke on-duty meal agreement
☐ Nature of work does not prevent relief from duties

Improper Waiver

☐ Pressured to sign meal waiver
☐ Meal waiver signed under duress
☐ Waiver applied when shift exceeded 6 hours (first meal) or 12 hours (second)
☐ Waiver language improper/unclear

Auto-Deduction Issues

☐ Time automatically deducted for meal break not taken
☐ Time automatically deducted for shortened meal break
☐ No process to report missed/shortened breaks

Retaliation

☐ Disciplined for taking meal breaks
☐ Hours reduced for taking meal breaks
☐ Terminated for taking or reporting meal break violations
☐ Other adverse action: _________________________

PART 7: DETAILED DESCRIPTION OF VIOLATION

Describe how the meal break violations occurred:
(Include specific examples, dates, circumstances, and who was involved)

_______________________________________________
_______________________________________________
_______________________________________________
_______________________________________________
_______________________________________________
_______________________________________________
_______________________________________________
_______________________________________________

What was the employer's reason or explanation for not providing meal breaks?
_______________________________________________
_______________________________________________

Did you report the meal break issues to management?
☐ Yes ☐ No

If yes:
- Date(s) reported: _________________________
- To whom: _________________________
- Response: _______________________________________________

PART 8: MEAL BREAK VIOLATION LOG

Record of Missed, Short, or Late Meal Periods:

(Continue on additional pages if necessary)

PART 9: PREMIUM PAY CALCULATION (CALIFORNIA)

Under California Labor Code § 226.7:
Employers must pay one additional hour of pay at the employee's regular rate of pay for each workday that a meal period is not provided.

Premium Pay Calculation:

Regular Hourly Rate: $_________________________

Violation Period:
- Start Date: _________________________
- End Date: _________________________ ☐ Ongoing

First Meal Period Violations:

Subtotal First Meal Violations: $_________________________

Second Meal Period Violations:

Subtotal Second Meal Violations: $_________________________

TOTAL DAMAGES CALCULATION

Note: Under California law, premium pay for meal and rest break violations is considered wages and is subject to waiting time penalties if not paid upon termination.

PART 10: SUPPORTING DOCUMENTATION

Documents Available (check all that apply):

☐ Time records/punch cards
☐ Work schedules
☐ Pay stubs (showing hours worked)
☐ Personal log of meal breaks
☐ Employee handbook/meal break policy
☐ Meal period waiver (if signed)
☐ On-duty meal period agreement
☐ Text messages/emails about breaks
☐ Witness statements
☐ Photographs (schedules, policies)
☐ Electronic records (clock-in/out data)
☐ Other: _________________________

PART 11: WITNESSES

Are there witnesses to the meal break violations?
☐ Yes ☐ No

Witness Information:

Witness 1:
- Name: _______________________________________________
- Position: _________________________
- Phone: _________________________
- What can they confirm? _______________________________________________

Witness 2:
- Name: _______________________________________________
- Position: _________________________
- Phone: _________________________
- What can they confirm? _______________________________________________

PART 12: OTHER AFFECTED EMPLOYEES

Are other employees affected by similar meal break violations?
☐ Yes ☐ No ☐ Unknown

If yes:
- Estimated number: _________________________
- Departments/positions: _______________________________________________
- Would they participate? ☐ Yes ☐ No ☐ Unknown

PART 13: STATE-SPECIFIC NOTES

CALIFORNIA

• Labor Code § 512: 30-minute meal period required for shifts over 5 hours
• Premium pay: One hour of pay for each workday meal period not provided
• Statute of Limitations: 3 years for meal break claims
• File with: Division of Labor Standards Enforcement (DLSE)
• Recent update: Premium pay is considered wages subject to waiting time penalties
• Website: www.dir.ca.gov/dlse

TEXAS

• No state meal break law for adult workers
• Federal law (FLSA) does not require meal breaks
• Breaks under 20 minutes must be paid; 30+ minute meal periods unpaid
• No state agency filing; federal claims only if minimum wage affected

FLORIDA

• No state meal break law for adult workers over 18
• Minors have break requirements
• No state enforcement mechanism
• Federal FLSA applies to unpaid break time

NEW YORK

• Factory workers: 60-minute noon meal for shifts 6am-6pm
• Mercantile/other industries: 30-minute meal between 11am-2pm
• Additional breaks for shifts starting before 11am and continuing after 7pm
• File with NY Department of Labor

PART 14: FILING OPTIONS

I plan to file this complaint with:

☐ California Division of Labor Standards Enforcement (DLSE)
- File a wage claim: www.dir.ca.gov/dlse/howtofilewageclaim.htm
- Phone: 1-844-522-6734
- Premium pay claims included in wage claim

☐ Other State Labor Agency
- State: _________________________
- Agency: _________________________
- Website: _________________________

☐ Private Attorney/Lawsuit
- May file individual or class action
- May recover premium pay, interest, penalties, attorney fees

☐ Small Claims Court
- For individual claims within jurisdictional limit
- California limit: $12,500 for individuals

PART 15: DECLARATION

I declare under penalty of perjury under the laws of the State of _________________________ that the foregoing is true and correct to the best of my knowledge and belief.

Complainant Signature: _______________________________________________

Printed Name: _______________________________________________

Date: _________________________

PART 16: ATTORNEY INFORMATION (IF APPLICABLE)

Attorney Name: _______________________________________________

Law Firm: _______________________________________________

Address: _______________________________________________

Phone: _________________________ Email: _________________________

Bar Number: _________________________

CHECKLIST BEFORE FILING

☐ Verified state has meal break laws
☐ All sections completed
☐ Violation dates documented
☐ Premium pay calculated
☐ Supporting documents gathered
☐ Copies made for records
☐ Statute of limitations verified
☐ Considered legal consultation

CALIFORNIA-SPECIFIC RESOURCES

• DLSE Meal Period FAQ: www.dir.ca.gov/dlse/faq_mealperiods.htm
• Labor Code § 512: leginfo.legislature.ca.gov
• IWC Wage Orders: www.dir.ca.gov/iwc/wageorderindustries.htm
• File Wage Claim: www.dir.ca.gov/dlse/howtofilewageclaim.htm

FREQUENTLY ASKED QUESTIONS

Q: Can my employer require me to stay on premises during my meal break?
A: In California, if you must stay on premises in a way that restricts your break, you may be entitled to premium pay unless there is a valid on-duty meal agreement.

Q: What if I choose to work through my meal break?
A: The employer must provide the opportunity for a meal break. If you voluntarily work through it without employer pressure, you may not be entitled to premium pay. Document carefully.

Q: Can I combine my meal break with rest breaks?
A: No. Meal periods and rest breaks are separate requirements and cannot be combined.

This template is provided for informational purposes only and does not constitute legal advice. Meal break laws vary significantly by state. Consult with a qualified employment attorney licensed in your state for advice specific to your situation.