Occupational Health and Safety Tribunal Canada
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Occupational Health and Safety Tribunal Canada

www.ohstc.gc.ca

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Application To Appeal

The HTML version of this application form is presented as an example only. To fill out and print an Application to Appeal please use the accessible PDF Version (397kb).

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Occupational Health and Safety Tribunal Canada
Arms of Canada




Tribunal de santé et sécurité au travail Canada
Ottawa, Canada K1A 0J2

Canada Labour Code Part IIOccupational Health and Safety

Application to appeal

I wish to appeal a decision of no danger made by a health and safety officer


 

or
 

I wish to appeal a direction issued by a health and safety officer


 


Name of the appellant:
______________________________________________


Title:
______________________________________________


Address:
______________________________________________


Telephone Number:
______________________________________________


E-mail address:
______________________________________________


Respondent:
______________________________________________


Name of health and safety officer:

______________________________________________


Date of decision or direction:

______________________________________________


Comments:
______________________________________________



Date____________________ Signature_____________________________

(Note: Please include a copy of the decision or direction if available and the reasons why you are appealing it.)

47 Clarence, Office 200,
Ottawa, ON, K1A 0J2
Tel: (613) 957-6344, 1-866-440-3343 Fax: (613) 954-6404

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Date Modified:
2014-02-25