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 11.5.5.1012 - SAMPLE PETITION FOR MODIFICATION OF ABATEMENT PERIOD
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 PETITIONER],
Petitioner,
v. [case no. omitted]
NEW MEXICO ENVIRONMENT DEPARTMENT
[and] [NAME OF RESPONSIBLE EMPLOYER],
respondent[s].
PETITION FOR MODIFICATION OF ABATEMENT PERIOD
TO: [Name and address of person who signed citation for department]
[Name of petitioner] petitions for amendment of the abatement dates for the following-listed items of the citation issued to [name of responsible employer] on [date]:
[List each item for which abatement date modification is requested, state what longer or shorter period is requested, and state reasons for request.]
[A copy/copies] of the relevant [citation(s)/item(s)] [is/are] attached hereto as Exhibit[s] A [through (last exhibit letter)].
Dated: [insert filing date] [Signature] ______________________________
[TYPED OR PRINTED NAME]
[Address of signer (use as many lines as necessary)]
[Signer's telephone number]
B. Usage note: Attached exhibits must be labelled ("EXHIBIT A", etc.) in the center of the bottom margin. Each citation should be a separate exhibit, but items within a single citation should be separate exhibits only if on non-consecutive pages. A certificate of service (Section 1001) [now 11.5.5.1001 NMAC], showing service on the responsible employer is required if the petition is filed by an affected employee or a representative of affected employees. An affidavit of posting (form 10) or affidavit of explanation for non-posting (Section 1010) [now 11.5.5.1010 NMAC] must be filed.
