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(Name), Area Director
U. S. Department of Labor—OSHA
Address of Area Office (on the citation)
[Company’s Name]
[Company‘s Address]
Check one:
Inspection Number _________________________________
Page ____ of ____
Citation Number(s)* _________________________________
Item Number(s)* _________________________________
Action | Proposed Completion Date (for abatement plans only) | Completion Date (for progress reports only) |
---|---|---|
1 | ||
2 | ||
3 | ||
4 | ||
5 | ||
6 | ||
7 | ||
Date required for final abatement:__________
I attest that the information contained in this document is accurate.
_________________________________Signature
_________________________________Typed or Printed Name
Name of primary point of contact for questions: [optional]
Telephone number: _________________________________
*Abatement plans or progress reports for more than one citation item may be combined in a single abatement plan or progress report if the abatement actions, proposed completion dates, and actual completion dates (for progress reports only) are the same for each of the citation items.