OSHAB Appeal Form

DIR OSHAB 100 - OSHAB APPEAL FORM. Use this form to appeal Citations and Items, Notification of Failure to Abate Alleged Violations, or Special Orders/Special Actions. Please fill out this form as completely as possible and provide all of the information requested. You must complete page 2 of this form separately for each citation and item or notification that you wish to appeal. Failure to provide the information requested could result in the dismissal of your appeal. An employer has 15 working days from receipt of one of the aforementioned documents for filing an appeal. An informal conference with the Division of Occupational Safety and Health about the citations issued to you will not extend the 15 working days to file an appeal. Appeals filed more than 15 working days following the employer’s receipt of citations are late and will not be accepted unless good cause for filing a late appeal is demonstrated. Only the Appeals Board may grant late appeals. Mail each completed appeal form as identified above to the Occupational Safety and Health Appeals Board, 2520 Venture Oaks Way, Suite 300, Sacramento, CA 95833. When the Appeals Board receives a signed, completed appeal form, it is reviewed for timeliness and assigned a case number which corresponds to your inspection number. All correspondence from the Appeals Board will be sent to the employer and any person designated as the employer’s representative on the appeal form. The correspondence will be sent either by postal mail or email, but not both, depending on what selection is made on the appeal form. If there is a change in the appointed representative or if the representative has a change in contact information (i.e. address, phone number, email address, etc.) after the appeal is filed, a written notification must be sent to the Appeals Board. www.FormsWorkflow.com