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 (32 KB).
Canada Labour Code Part II – Occupational Health and Safety
Application to appeal
I wish to appeal a decision regarding a refusal to work: that a danger does not exist
That the danger is a normal condition of employment
That the refusal puts the life, health or safety of another person directly in danger
I wish to appeal a direction
I wish to appeal for a stay of the direction
Please include a copy of the decision(s) or direction(s) if available.
47 Clarence Street, Office 200, Ottawa, Ontario, K1A 0J2
Telephone number: 613-437-0612 or 1-866-440-3343
Facsimile number: 613-437-0600
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