Appendix A to §1903.19—Sample abatement certification letter (non-mandatory)

(Name), Area Director
U. S. Department of Labor—OSHA
Address of the Area Office (on the citation)

[Company’s Name]
[Company‘s Address]

The hazard referenced in Inspection Number [insert 9-digit #] for violation identified as:

Citation [insert #] and item [insert #] was corrected on [insertdate] by:
________.

Citation [insert #] and item [insert #] was corrected on [insert date] by:
________.

Citation [insert #] and item [insert #] was corrected on [insert date] by:
________.

Citation [insert #] and item [insert #] was corrected on [insert date] by:
________.

Citation [insert #] and item [insert #] was corrected on [insert date] by:
________.

Citation [insert #] and item [insert #] was corrected on [insert date] by:
________.

Citation [insert #] and item [insert #] was corrected on [insert date] by:
________.

Citation [insert #] and item [insert #] was corrected on [insert date] by:
________.

I attest that the information contained in this document is accurate.

_________________________________ Signature

_________________________________Typed or Printed Name