California Code of Regulations
Title 8 - Industrial Relations
Division 1 - Department of Industrial Relations
Chapter 3.2 - California Occupational Safety and Health Regulations (Cal/OSHA)
Subchapter 2 - Regulations of the Division of Occupational Safety and Health
Article 1.5 - Employer's Declaration of Abatement and Other Documentation of Abatement-Employee Notification-Posting Requirements
Appendix B to Section 1903.19 - Sample Abatement Plan or Progress Report (Non-Mandatory)
(Name), District Manager
Division of Occupational Safety and Health
Address of the District Office (on the citation)
[Company's Name]
[Company's Address]
Check one:
Abatement Plan [ ]
Progress Report [ ]
Inspection Number
Page __________ of ____________________
___________________________
Citation Number(s) * ___________________________
Item Numbers_____________________________________________
| Action | Proposed Completion Date (for abatement plans only) | Completion Date (for progress reports only) |
1. _____________________________________________________
2. _____________________________________________________
Date required for final abatement:
I attest that the information contained in this document is accurate. (NOTE: For serious violations the document must be submitted under penalty of perjury. See Appendix A, above)
___________________________
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.
