Appendix B. Sample Abatement Plan or Progress Report (Nonmandatory)

(Name), Director

The Industrial Commission of Arizona Division of Occupational Safety and Health

P. O. Box 19070 Phoenix, Arizona 85005

[Company’s Name] [Company’s Address]

Check one: Abatement Plan  [  ] Progress Report  [  ]

Action		Proposed Completion Date (for abatement plans only)	Completion Date (for progress reports only)
1.	...................... ...................... ......................	...................	...................
2.	...................... ...................... ......................	...................	...................
3.	......................	...................	...................

  

 

Inspection Number                                                 Page               of_                            Citation Number(s)*                                Item Number(s)*                                                

......................

......................

4.     ......................          ...................             ...................

......................

......................

5.     ......................          ...................             ...................

......................

......................

Date required for final abatement:                                         I attest that the information contained in this document

is accurate.

Signature

Typed or Printed Name

Name of primary point of contact for questions: (optional) Telephone number:         

*Abatement plans or progress reports for more than one citation item may be combined in a single abatement plan or progress report if the abatement actions, proposed completion dates, and actual completion dates (for prog- ress reports only) are the same for each of the citation items.

Historical Note

Appendix B adopted effective June 26, 1998 (Supp. 98-2).

Historical Note

Appendix C adopted effective June 26, 1998 (Supp. 98-2).