New York Codes, Rules and Regulations
Title 12 - DEPARTMENT OF LABOR
Chapter I - Industrial Board Of Appeals
Subchapter B - Rules Of Procedure And Practice
Part 72 - Applications For Stay From Notice Of Dangerous Condition ("unsafe Notice") Issued Pursuant To Section 200(2) Of Labor Law
Section 72.3 - Form and content of petition

(a) contain a caption in the following form:

STATE OF NEW YORK

INDUSTRIAL BOARD OF APPEALS

X...................................................................................................................

- :...................................................................................................................

In the Matter of the Application of.. :...................................................................................................................

: (insert name of applicant)...................................................................................................................

For a stay to permit use after issuance of an

...................................................................................................................

Applicant,

:

"unsafe notice" by the Commissioner of Labor.. :...................................................................................................................

declaring unsafe and prohibiting the use of (identify subject in issue).. :................................................

....................................................................................

-against-

:

The Commissioner of Labor,.. :...................................................................................................................

:

Respondent.

:

..X...................................................................................................................

(b) state the address of the applicant;

(c) state the address and location of the machinery, equipment, device or area which is the subject of the notice;

(d) describe the machinery, equipment, device or area prohibited to be used;

(e) describe the manner in which the machinery, equipment, device or area is used or operated;

(f) state whether the persons using the machinery, equipment, device or area have any special training or competence and the extent of their supervision, if any;

(g) annex a complete copy of the notice sought to be stayed, including copies of any other orders, notices and supporting documents issued in connection therewith;

(h) state the facts showing why the notice is erroneous or unreasonable and, where possible, submit affidavits or other reliable, relevant evidence to justify a stay;

(i) set forth the relief requested; and

(j) be signed and verified by applicant or an authorized representative.