Free Abatement Form - Tennessee

HOW TO USE THE ABATEMENT FORM
1) 2) 3) 4) Mail to the AREA OFFICE at the address shown in the original citation. Use regular First Class mail. Keep this form as a master and record of submission and make copies as needed. This form may be used to: a) Report progress on correction of items cited. b) Request extensions of the time for correction. c) File a Notice of Contest. Examples of how to complete this form:

5)

Citation & Item # 1/1 1/1a

Date Corrected 02/16/01 02/16/01

2/1

PROGRESS REPORT

2/2

REQUEST EXTENSION OF ABATEMENT PERIOD

*** HOW CORRECTED (Safety) Gate-type barrier guard installed. Press will not operate unless gate is closed. (Health) A respirator (A O Model R 4055 with a HEPA filter) has been issued to the spray painter at No. 1 spray booth. Wearing of the respirator is mandatory while spraying. Attached is a copy of our written respirator program which covers minimum acceptable requirements as listed in 29 CFR 1910.134. (Safety) New ladders on order. Old ladder removed from use. Expect correction to be complete by 03/15/01. (Health) Backflow preventers have been ordered and should be installed on fresh water lines to the plating tanks by 03/15/01. When requesting an extension of abatement time, the following information must be provided and such request must be submitted no later than one (1) day following the abatement date listed on the Citation Notification of Penalty. a. What has been done to date to correct? b. Explain factors beyond your control which have delayed correction of the item. c. Request extension to a specific date. d. State interim measures being taken to safeguard employees of the hazard until it can be corrected. e. Certify that a copy of the request was posted or given to employees or their representative and the date posted or served and that employees have been informed of their right to contest the requested extension. (Safety) We ordered self-closing valves on 12/15/00 (P.O. #763) and were informed they would be shipped 12/16/00. Request extension to 03/15/01. As an interim safety precaution, we temporarily moved this drum of liquid outside the plant.

EXAMPLES (Health) We ordered deluge showers on 12/15/00 (P.O. #76) and were informed that they would be shipped 12/16/00. Request extension until 01/17/01. As an interim safety precaution, we temporarily provided rubber water hoses at faucets near the plating tanks. Personal protective equipment is mandatory for this area. I certify that a copy of this request was posted on the employee's bulletin board on (date) and that employees have been informed of their rights under the Act. We hereby submit formal notice that we are contesting this alleged violation and the proposed penalty (if any). (Safety) Guard rail installed (Health) Eye wash installed by acid mixing station.

2/3 2/4

NOTICE OF CONTEST 02/10/01

ABATEMENT FORM
AREA SUPERVISOR Tennessee Department of Labor and Workforce Development Division of Occupational Safety and Health (Mail to the area office address listed in the original citation) Date

SUBMITTED BELOW IS OUR RESPONSE TO THE ALLEGED VIOLATION(S) LISTED ON THE CITATION(S) AS THE RESULT OF YOUR INSPECTION NUMBER: __________________________________ AND ISSUED TO: Name of Establishment______________________________________________________
Citation & Item # Date Corrected

How Corrected

A COPY OF THE CITATION(S) WAS (WERE) POSTED AS REQUIRED BY TENNESSEE CODE ANNOTATED §50-3-307(a)(4).

Employer Official's Signature

Job Title