Based on the Citation and Notification of Penalty letter you received in Unit III, prepare a document that summarizes at lea

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 employer’s 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 intend to contest the citation(s) and/or proposed

penalty(ies) within 15 working days after receipt, the citation(s) and the proposed

penalty(ies) will become a final order of the Occupational Safety and Health Review

Commission and may not be reviewed by any court or agency.

Penalty Payment – Penalties are due within 15 working days of receipt of this notification

unless contested. (See the enclosed booklet and the additional information provided related to

the Debt Collection Act of 1982.) Make your check payable to “DOL-OSHA”. Please indicate the

inspection number on the remittance.

OSHA does not agree to any restrictions or conditions or endorsements put on any check or

money order for less than the full amount due and will cash the check or money order as if

these restrictions, conditions, or endorsements do not exist.

Notification of Corrective Action – For each violation which you do not contest, you are

required by 29 CFR 1903.19 to submit an Abatement Certification to the area director of the

OSHA office issuing the citation, identified above. The certification must be sent by you within

10 calendar days of the abatement date indicated on the citation. For willful and repeat

violations, documents (e.g., photos, copies of receipts, training records) demonstrating that

abatement is complete must accompany the certification. Where the citation is classified as

serious and the citation states that abatement documentation is required, documents such as

those described above are required to be submitted along with the abatement certificate. If the

citation indicates that the violation was corrected during the inspection, no abatement

certification is required for that item.

All abatement verification documents must contain the following information: 1) Your

name and address; 2) the inspection number (found on the front page); 3) the citation and

citation item number(s) to which the submission relates; 4) a statement that the information is

accurate; 5) the signature of the employer or employer’s authorized representative; 6) the date

the hazard was corrected; 7) a brief statement of how the hazard was corrected; and 8) a

statement that affected employees and their representatives have been informed of the

abatement.

The law also requires a copy of all abatement verification documents, required by 29 CFR

1903.19, to be sent to OSHA and also be posted at the location where the violation appeared

and the corrective action took place.

Employer Discrimination Unlawful – The law prohibits discrimination by an employer against

an employee for filing a complaint or for exercising any rights under this Act. An employee who

believes that he/she has been discriminated against may file a complaint no later than 30 days

after the discrimination occurred with the U.S. Department of Labor Area Office at the address

shown above.

Employer Rights and Responsibilities – The enclosed booklet (OSHA 300) outlines

additional employer rights and responsibilities and should be read in conjunction with this

notification.

Notice to Employees – The law gives an employee or his/her representative the opportunity to

object to any abatement date set for a violation if he/she believes the date to be unreasonable.

The contest must be mailed to the U.S. Department of Labor Area Office at the address shown

above and postmarked within 15 working days (excluding weekends and federal holidays) of the

receipt by the employer of this Citation and Notification of Penalty.

Inspection Activity Data – You should be aware that OSHA publishes information on its

inspection and citations activity on the Internet under the provisions of the Electronic Freedom

of Information Act. The information related to your inspection will be available 30 calendar days

after the citation issuance date. You are encouraged to review the information concerning your

establishment at www.osha.gov. If you have any dispute with the accuracy of the information

displayed, please contact the office.

U.S. Department of Labor

Occupational Safety and Health Administration

NOTICE TO EMPLOYEES OF INFORMAL CONFERENCE

An informal conference has been scheduled with OSHA to discuss the

citation(s) issued on 08/21/21015. The conference will be held at the OSHA

office located at Denver Commons Office Plaza, 111 Main St., Suite 111,

Denver, CO 11111 on ________ at __________. Employees and/or

representatives of employees have a right to attend an informal

conference.

CERTIFICATION OF CORRECTIVE ACTION WORKSHEET

Inspection Number:

Company Name:

Inspection Site:

Issuance Date:

List the specific method of correction for each item on this citation in this package that does not

read "Corrected During Inspection" and return to: U.S. Department of Labor – Occupational

Safety and Health Administration, Denver Commons Office Plaza, 111 Main St., Suite 111,

Denver, CO 11111

Citation Number ____ and Item Number ____ was corrected on _______________ By (Method

of Abatement):_______________________________________________________________

Citation Number ____ and Item Number ____ was corrected on _______________ By (Method

of Abatement): _______________________________________________________________

Citation Number ____ and Item Number ____ was corrected on _______________ By (Method

of Abatement): _______________________________________________________________

Citation Number ____ and Item Number ____ was corrected on _______________ By (Method

of Abatement): _______________________________________________________________

Citation Number ____ and Item Number ____ was corrected on _______________ By (Method

of Abatement): _______________________________________________________________

Citation Number ____ and Item Number ____ was corrected on _______________ By (Method

of Abatement): _______________________________________________________________

I certify that the information contained in this document is accurate and that the affected

employees and their representatives have been informed of the abatement.

________________________ ____________________________

Signature Date

________________________ ____________________________

Typed or Printed Name Title

NOTE-: 29 USC 666(g) whoever knowingly makes any false statements, representation or

certification in any application, record, plan or other documents filed or required to be

maintained pursuant to the Act shall, upon conviction, be punished by a fine of not more than

$10,000 or by imprisonment of not more than 6 months or both. POSTING: A copy of completed

Corrective Action Worksheet should be posted for employee review

U.S. DEPARTMENT OF LABOR

OCCUPATIONAL SAFETY AND HEALTH ADMINISTRATION

CERTIFICATE OF CORRECTION

The undersigned certifies that on ______________, all of the violations

cited on OSHA Citation # ____________ issued on _________, were

corrected and that a copy of this certificate was posted on _________ in a

manner and place for review by affected employees.

______________________

Employer’s Signature

U.S. Department of Labor Inspection Number: 111111111

Occupational Safety and Health Administration Inspection Date(s): 04/15/2015-04/16/2015 Issuance Date: 08/21/2015

Citation and Notification of Penalty

Company Name: Acme Widget Factory

Inspection Site: 1 Factory Lane, Inglewood, CO 11111-1111

The alleged violations below have been grouped because they involve similar or related hazards that may increase the potential for injury or illness.

Citation 1 Item 1a Type of Violation: Serious

29 CFR 1910.1025(c)(1) Exposure levels to lead fumes during welding operations were

not kept below the established permissible exposure level (PEL).

(a) Location – Frame Assembly Area On 04/15/15, a MIG welder in the frame assembly area was exposed to lead at an airborne time weighted average (TWA) exposure of 100 µg/m3. This exposure was approximately 2 times the permissible exposure limit (PEL) of 50 ug/m3. This exposure was calculated from a sample collected over a 410 minute period; a zero increment was included for the 70 minutes not sampled.

(b) Location – Frame Assembly Area On 04/15/15 a MIG welder in the frame assembly area was exposed to lead at an airborne time weighted average (TWA) exposure of 80 µg/m3. This exposure was approximately 2 times the permissible exposure limit (PEL) of 50 ug/m3. This exposure was calculated from a sample collected over a 400 minute period; a zero increment was included for the 80 minutes not sampled.

ABATEMENT DOCUMENTATION REQUIRED FOR THIS ITEM

Date by which violation must be abated: 09/28/2015 Proposed Penalty: $7000.00

U.S. Department of Labor Inspection Number: 111111111

Occupational Safety and Health Administration Inspection Date(s): 04/15/2015-04/16/2015 Issuance Date: 08/21/2015

Citation and Notification of Penalty

Company Name: Acme Widget Factory

Inspection Site: 1 Factory Lane, Inglewood, CO 11111-1111

Citation 1 Item 1b Type of Violation: Serious 29 CFR 1910.1025(e)(1)(ii): Where an employee was exposed to lead above the permissible exposure limit, but for 30 days or less per year, engineering controls were not implemented to reduce exposures to 200 ug/m3: Engineering controls were not implemented to reduce the exposure to employees overexposed to Lead. Engineering controls usually effective in these circumstances include, but are not limited to, the following: 1. Modification of the existing ventilation system to improve capture velocity at the ventilation hoods. 2. Modification of ventilation hoods to better collect metal fumes, Abatement Steps STEP 1: Effective respirators shall be provided and used by all employee(s) as an interim measure. Abatement must be completed by September 1, 2015.

U.S. Department of Labor Inspection Number: 111111111

Occupational Safety and Health Administration Inspection Date(s): 04/15/2015-04/16/2015 Issuance Date: 08/21/2015

Citation and Notification of Penalty

Company Name: Acme Widget Factory

Inspection Site: 1 Factory Lane, Inglewood, CO 11111-1111

STEP 2: Submit to the Area Director a written detailed plan of abatement outlining a schedule for the implementation of engineering measures to control employee exposures as referenced in this citation. This plan shall include, at a minimum, target dates for the following actions which must be consistent with the dates required by this citation. a) Evaluation of the extent and location of the hazard source. b) Evaluation of control measure options. c) Selection of optimum control method(s). d) Determination of control measure design. e) Ordering and delivery of equipment and material(s). f) Installation of control measures. g) Training of employees in proper operation and maintenance of newly-implemented control measures. h) Assurance of effective performance of control measures. All proposed control measures shall be evaluated for each particular use by a technically qualified person. Abatement must be completed by September 1, 2015. STEP 3: Correction should have been completed by the implementation of feasible engineering controls and air sampling results to verify the effectiveness in achieving compliance. Abatement must be completed by September 1, 2015. ABATEMENT DOCUMENTATION REQUIRED FOR THIS ITEM Date By Which Violation Must be Abated: 09/28/2015

U.S. Department of Labor Inspection Number: 111111111

Occupational Safety and Health Administration Inspection Date(s): 04/15/2015-04/16/2015 Issuance Date: 08/21/2015

Citation and Notification of Penalty

Company Name: Acme Widget Factory

Inspection Site: 1 Factory Lane, Inglewood, CO 11111-1111

Citation 1 Item 2 Type of Violation: Serious

29 CFR 1910.134(c)(1): A written respiratory protection program that included the

provisions in 1910.134(c)(1)(i) – (ix) with worksite specific procedures was not

established and implemented for required respirator use: No written program was

developed for employees who were overexposed to lead and who are required to wear

respirators while working in the frame assembly area.

ABATEMENT DOCUMENTATION REQUIRED FOR THIS ITEM

Date By Which Violation Must be Abated: 09/28/2015

Proposed Penalty: $4900.00

U.S. Department of Labor Inspection Number: 111111111

Occupational Safety and Health Administration Inspection Date(s): 04/15/2015-04/16/2015 Issuance Date: 08/21/2015

Citation and Notification of Penalty

Company Name: Acme Widget Factory

Inspection Site: 1 Factory Lane, Inglewood, CO 11111-1111

Citation 1 Item 3 Type of Violation: Serious

29 CFR 1910.13 4(e)(1): The employer did not provide a medical evaluation to

determine the employee’s ability to use a respirator, before the employee is fit-tested or

required to use the respirator in the workplace: At least three employees who were

required to use respiratory protection while working in the frame assembly area were

not provided a medical evaluation.

ABATEMENT DOCUMENTATION REQUIRED FOR THIS ITEM

Date By Which Violation Must be Abated: 09/28/2015

Proposed Penalty: $3500.00

U.S. Department of Labor Inspection Number: 111111111

Occupational Safety and Health Administration Inspection Date(s): 04/15/2015-04/16/2015 Issuance Date: 08/21/2015

Citation and Notification of Penalty

Company Name: Acme Widget Factory

Inspection Site: 1 Factory Lane, Inglewood, CO 11111-1111

The alleged violations below have been grouped because they involve similar or related hazards that may increase the potential for injury or illness.

Citation 1 Item 4a Type of Violation: Serious

29 CFR 1910.134(f)(1): The employer did not ensure that employees using a tight-fitting

facepiece respirator pass an appropriate qualitative fit test (QLFT) or quantitative fit test

(QNFT) as stated in 29 CFR 1910(f): No fit testing was done for employees who were

overexposed to lead and who are required to wear respirators while working in the

frame assembly area.

ABATEMENT DOCUMENTATION REQUIRED FOR THIS ITEM

Date By Which Violation Must be Abated: 09/28/2015

Proposed Penalty: $4900.00

U.S. Department of Labor Inspection Number: 111111111

Occupational Safety and Health Administration Inspection Date(s): 04/15/2015-04/16/2015 Issuance Date: 08/21/2015

Citation and Notification of Penalty

Company Name: Acme Widget Factory

Inspection Site: 1 Factory Lane, Inglewood, CO 11111-1111

Citation 1 Item 4b Type of Violation: Serious

29 CFR 1910.134(g)(1)(i)(A): Respirators with tight-fitting facepieces were worn by

employees who had facial hair that came between the sealing surface of the facepiece

and the face or that interfered with valve function: Two employees, who wore half mask

3M respirators, had beards which interfered with the face seal.

ABATEMENT DOCUMENTATION REQUIRED FOR THIS ITEM

Date By Which Violation Must be Abated: 09/28/2015

U.S. Department of Labor Inspection Number: 111111111

Occupational Safety and Health Administration Inspection Date(s): 04/15/2015-04/16/2015 Issuance Date: 08/21/2015

Citation and Notification of Penalty

Company Name: Acme Widget Factory

Inspection Site: 1 Factory Lane, Inglewood, CO 11111-1111

Citation 1 Item 5 Type of Violation: Serious

29 CFR 1910.134(k)(1): The employer did not ensure that each employee can

demonstrate knowledge of at least 29 CFR 1910.134(h)(1)(i) through(vii): At least three

employees who were required to use respiratory protection while working in the frame

assembly area were not trained in the use of respirators.

ABATEMENT DOCUMENTATION REQUIRED FOR THIS ITEM

Date By Which Violation Must be Abated: 09/28/2015

Proposed Penalty: $4900.00

U.S. Department of Labor Inspection Number: 111111111

Occupational Safety and Health Administration Inspection Date(s): 04/15/2015-04/16/2015 Issuance Date: 08/21/2015

Citation and Notification of Penalty

Company Name: Acme Widget Factory

Inspection Site: 1 Factory Lane, Inglewood, CO 11111-1111

Citation 1 Item 6 Type of Violation: Serious

29 CFR 1910.147(c)(1): The employer did not establish a program consisting of an

energy control procedure and employee training to ensure that before any employee

performed any servicing or maintenance on a machine or equipment where the

unexpected energizing, start up or release of stored energy could occur and cause

injury, the machine or equipment would be isolated, and rendered inoperative in

accordance with 29 CFR 1910.147(c)(4): No energy control program was developed for

employees who work on equipment including, but not limited to, the mechanical

presses.

ABATEMENT DOCUMENTATION REQUIRED FOR THIS ITEM

Date By Which Violation Must be Abated: 09/28/2015

Proposed Penalty: $2800.00

U.S. Department of Labor Inspection Number: 111111111

Occupational Safety and Health Administration Inspection Date(s): 04/15/2015-04/16/2015 Issuance Date: 08/21/2015

Citation and Notification of Penalty

Company Name: Acme Widget Factory

Inspection Site: 1 Factory Lane, Inglewood, CO 11111-1111

Citation 1 Item 7 Type of Violation: Serious

29 CFR 191 0.1200(f)(5)(i): The employer did not ensure that each container of

hazardous chemicals in the workplace was labeled, tagged or marked with the identity

of the hazardous chemical( s) contained therein: a) At the jobsite – The employer did not

ensure that each container of hazardous chemicals in the workplace was labeled with

legible markings. The labels for three 5 gallon jugs containing clear liquids were not

labeled. Employees in the area could not determine what the liquids were. Observed on

04/15/2015 Abatement certification required within 10 days after abatement date. The

certification shall include a statement that abatement is complete, date and method of

abatement, and state employees and their representatives were informed of this

abatement.

ABATEMENT DOCUMENTATION REQUIRED FOR THIS ITEM

Date By Which Violation Must be Abated: 09/28/2015

Proposed Penalty: $3000.00

U.S. Department of Labor Inspection Number: 111111111

Occupational Safety and Health Administration Inspection Date(s): 04/15/2015-04/16/2015 Issuance Date: 08/21/2015

Citation and Notification of Penalty

Company Name: Acme Widget Factory

Inspection Site: 1 Factory Lane, Inglewood, CO 11111-1111

Citation 1 Item 8 Type of Violation: Serious

29 CFR 1910.1200(g)(8): The employer did not maintain in the workplace copies of the

required safety data sheets for each hazardous chemical, and did not ensure that they

were readily accessible during each work shift to employees when they were in their

work area( s)

The employer did not maintain safety data sheets to assist employees working with

hazardous chemicals such as, but not limited to, Methyl Ethyl Ketone, Acetone, and

Sulfuric Acid. Observed on 04/15/2015. Abatement certification required within 10 days

after abatement date. The certification shall include a statement that abatement is

complete, date and method of abatement, and states employees and their

representatives were informed of this abatement.

ABATEMENT DOCUMENTATION REQUIRED FOR THIS ITEM

Date By Which Violation Must be Abated: 09/28/2015

Proposed Penalty: $3000.00

U.S. Department of Labor Inspection Number: 111111111

Occupational Safety and Health Administration Inspection Date(s): 04/15/2015-04/16/2015 Issuance Date: 08/21/2015

Citation and Notification of Penalty

Company Name: Acme Widget Factory

Inspection Site: 1 Factory Lane, Inglewood, CO 11111-1111

Citation 1 Item 9 Type of Violation: Serious

29 CPR 191 0.178(1)(1 )(ii): Prior to permitting an employee to operate a powered

industrial truck (except for training purposes), the employer shall ensure that each

operator has successfully completed the training required by this paragraph (1), except

as permitted by paragraph (1)(5):

a. The employer did not ensure that employees received a combination of formal

instruction (e.g., lecture, discussion, interactive computer learning, video tape,

written material), practical training (demonstrations performed by the trainer and

practical exercises performed by the trainee), and an evaluation of the operator's

performance in the workplace prior to permitting each employee to operate a

powered industrial truck.

ABATEMENT DOCUMENTATION REQUIRED FOR THIS ITEM

Date By Which Violation Must be Abated: 09/28/2015

Proposed Penalty: $5500.00

U.S. Department of Labor Inspection Number: 111111111

Occupational Safety and Health Administration Inspection Date(s): 04/15/2015-04/16/2015 Issuance Date: 08/21/2015

Citation and Notification of Penalty

Company Name: Acme Widget Factory

Inspection Site: 1 Factory Lane, Inglewood, CO 11111-1111

Citation 1 Item 10 Type of Violation: Serious

29 CFR 1910.305(g)(l)(iv)(A): Flexible cords and/or cables were used as a substitute

for the fixed wiring of a structure:

Employees were exposed to electrical shock hazards while operating equipment

such as, but not limited to computers controlling production equipment which were

plugged into temporary electrical wiring:

a) Management had rerouted some of the computers from the press area to a

neighboring office by using an electrical cord attached to a surge protector and

routing it though the AC vent to the office.

b) At least 5 relocatable power taps were being used with one electrical wall 120V

receptacle to provide power to at least 10 electrical devices such as, but not limited

to, computers in the manufacturing area, office phones, cell phone chargers, and

printers.

c) Several extension cords ran across the floor to computers in the production area

and were not secured.

U.S. Department of Labor Inspection Number: 111111111

Occupational Safety and Health Administration Inspection Date(s): 04/15/2015-04/16/2015 Issuance Date: 08/21/2015

Citation and Notification of Penalty

Company Name: Acme Widget Factory

Inspection Site: 1 Factory Lane, Inglewood, CO 11111-1111

ABATEMENT DOCUMENTATION REQUIRED FOR THIS ITEM.

Date By Which Violation Must be Abated: 09/28/2015

Proposed Penalty: $7000.00

U.S. Department of Labor Inspection Number: 111111111

Occupational Safety and Health Administration Inspection Date(s): 04/15/2015-04/16/2015 Issuance Date: 08/21/2015

Citation and Notification of Penalty

Company Name: Acme Widget Factory

Inspection Site: 1 Factory Lane, Inglewood, CO 11111-1111

Citation 1 Item 11 Type of Violation: Serious

OSH Act of 1970 Section 5(a)(1): The employer did not furnish employment and a place of employment which were free from recognized hazards that were causing or likely to cause death or serious physical harm to employers, in that employees were exposed to chemicals that could be injurious to the eyes with no emergency eyewash within 300 feet.

a. Employees in the parts washing area were using large quantities of methyl ethyl ketone and acetone to clean parts. The process required employees to place large parts into a solvent cleaning station and spray the parts with Solven100®, a mixture containing 75% MEK and 25% acetone. The spraying process created a high risk of the chemical splashing into the employee’s eyes.

ABATEMENT DOCUMENTATION REQUIRED FOR THIS ITEM

Date By Which Violation Must be Abated: 09/28/

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