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Note: Appendices A through C provide information and nonmandatory guidelines to assist employers and employees in complying with the appropriate requirements of this section.

(Name), Area Director
U. S. Department of Labor -- OSHA
Address of the Area Office (on the citation)

[Company's Name]
[Company's Address]

 The hazard referenced in Inspection Number [insert 9-digit #]
for violation identified as:

Citation [insert #] and item [insert #] was corrected on [insert
date] by:

______________________________________________________________________
____________________.

Citation [insert #] and item [insert #] was corrected on [insert
date] by:

______________________________________________________________________
____________________.

Citation [insert #] and item [insert #] was corrected on [insert
date] by:

______________________________________________________________________
____________________.

Citation [insert #] and item [insert #] was corrected on [insert
date] by:

______________________________________________________________________
____________________.

Citation [insert #] and item [insert #] was corrected on [insert
date] by:

______________________________________________________________________
____________________.

Citation [insert #] and item [insert #] was corrected on [insert
date] by:

______________________________________________________________________
____________________.

Citation [insert #] and item [insert #] was corrected on insert date
by:

______________________________________________________________________
____________________.

Citation [insert #] and item [insert #] was corrected on [insert
date] by:

______________________________________________________________________
____________________.

I attest that the information contained in this document is
accurate.

______________________________________________________________________
   Signature

______________________________________________________________________
   Typed or Printed Name

[62 FR 15324, March 31, 1997]