New Mexico Administrative Code
Title 11 - LABOR AND WORKERS' COMPENSATION
Chapter 5 - OCCUPATIONAL HEALTH AND SAFETY
Part 5 - OCCUPATIONAL HEALTH AND SAFETY REVIEW COMMISSION PROCEDURES
Section 11.5.5.1010 - SAMPLE AFFIDAVIT OF EXPLANATION FOR NON-POSTING

Universal Citation: 11 NM Admin Code 11.5.5.1010

Current through Register Vol. 35, No. 18, September 24, 2024

A. Format:

STATE OF NEW MEXICO

BEFORE THE OCCUPATIONAL HEALTH AND SAFETY REVIEW COMMISSION

[NAME OF COMPLAINANT OR PETITIONER],

[complainant/petitioner],

v. No. [insert case no.]

[NAME(S) OF RESPONDENT(S)],

respondent(s).

AFFIDAVIT OF EXPLANATION FOR NON-POSTING

STATE OF [NAME OF STATE IN WHICH AFFIDAVIT SIGNED])

) ss.

COUNTY OF [NAME OF COUNTY IN WHICH AFFIDAVIT SIGNED])

[Name of person signing affidavit], being duly sworn, states:

1. I am the [title] of the [respondent/petitioner], [name of party], and I am authorized to make this affidavit.

2. A notice to affected employees ([specific type of notice]) was not posted because [brief explanation of reason for not posting].

[Signature] _______________________________

[TYPED OR PRINTED NAME]

[Address of signer (use as many lines as necessary)]

[Signer's telephone number]

SUBSCRIBED AND SWORN TO before me by [name of person signing affidavit] on [date].

[Signature of notary] _______________________

Notary public

My commission expires:

[Expiration date]

B. Usage note: If applicable, include certificate of service (Section 1001) [now 11.5.5.1001 NMAC], on or immediately following the signature page.

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