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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.
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.
§340.4. Declaration of Abatement, Other Documentation, Employee Notification and Posting Requirements
(Name), District Manager
Division of Occupational Safety and Health
Address of the District Office (on the citation)
[Company's Name]
[Company's Address]
The hazard referenced in Inspection Number [insert 9-digit #] for violation identified as:
Citation [insert #] and item [insert #] was corrected on [insert date] by: ________________________________.
Citation [insert #] and item [insert #] was corrected on [insert date] by: _____________________.
(NOTE: Follow sample format for each citation or item) I attest that the information contained in this document is accurate. _________________________
Signature ______________________________________________________
Typed or Printed Name __________________________________________
Note: For serious violations the submittal must be made under penalty of perjury. For Example:
“I declare under penalty of perjury the foregoing is true and correct.
Executed this ________ day of (month) in the city of _________________, California. __________”
(Signature) ____________________________________________________
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