U.S. Department of Labor
Occupational Safety and Health Administration
Denver Commons Office Plaza
111 Main St., Suite 111
Denver, CO 11111
Phone: (111) 111-1111 FAX: (222) 222-2222
Citation and Notification of Penalty
To: Inspection Number: 111111111 Acme Widget Factory Inspection Date(s): 04/15/2015-04/16/2015 and its successors Issuance Date: 08/21/2015 1 Factory Lane
Inglewood, CO 11111-1111
Inspection Site: The violation(s) described in this citation and 1 Factory Lane Notification of Penalty is (are) alleged to have Inglewood, CO 11111-1111 occurred on or about the day(s) the inspection was made unless otherwise indicated within the
description given below.
This Citation and Notification of Penalty (this citation) describes violations of the Occupational
Safety and Health Act of 1970. The penalty(ies) listed herein is (are) based on these violations.
You must abate the violations referred to in this citation by the dates listed, and pay the
penalties proposed unless, within 15 working days (excluding weekends and federal holidays)
from your receipt of this Citations and Notification of Penalty, you mail a notice of contest to the
U.S. Department of Labor Area Office at the address shown above. Please refer to the enclosed
booklet (OSHA 300) which outlines your rights and responsibilities and should be read in
conjunction with this form. Issuance of this citation does not constitute a finding that a violation
of the Act has occurred unless there is a failure to contest as provided for in the Act or, if
contested, unless this citation is affirmed by the Review Commission or a court.
Posting The law requires that a copy of this Citation and Notification of Penalty be posted
immediately in a prominent place at or near the location of the violation(s) cited herein, or, if it is
not practicable because of the nature of the employers operations, where it will be readily
observable by all affected employees. This citation must remain posted until the violation(s)
cited herein has (have) been abated, or for 3 working days (excluding weekends and federal
holidays)whichever is longer. The penalty dollar amounts need not be posted and may be
marked out or covered up prior to posting.
Informal Conference An informal conference is not required. However, if you wish to have
such a conference you may request one with the area director during the 15 working day
contest period. During such an informal conference, you may present any evidence or views
which you believe would support an adjustment to the citation(s) and/or penalty(ies).
If you are considering a request for an informal conference to discuss any issues related to this
Citation and Notification of Penalty, you must take care to schedule it early enough to allow time
to contest after the informal conference, should you decide to do so. Please keep in mind that a
written letter of intent to contest must be submitted to the area director within 15 working days of
your receipt of this citation. The running of this contest period is not interrupted by an informal
conference.
If you decide to request an informal conference, please complete, remove, and post the page 4
Notice to Employees next to this Citation and Notification of Penalty as soon as the time, date,
and place of the informal conference have been determined. Be sure to bring to the conference
any and all supporting documentation of existing conditions, as well as any abatement steps
taken thus far. If conditions warrant, we can enter into an informal settlement agreement which
amicably resolves this matter without litigation or contest.
Right to Contest You have the right to contest this Citation and Notification of Penalty. You
may contest all citation items or only individual items. You may also contest proposed penalties
and/or abatement dates without contesting the underlying violations. Unless you inform the
area director in writing that you i
