The form covers Buildings/Structures, Scaffolding/Falsework, Demolition and Trenches/Excavations.
Fax notification: do not mail duplicate notification as a follow-up to fax notification.
Who completes it: the appropriate item(s) must be completed and signed by a person knowledgeable about the project for each activity covered by a permit.
Scaffolding: metal over 125 feet or wood over 60 feet requires design by a California Registered Civil Engineer and plans at site.
Trenches: ground protection methods for excavations deeper than 20 feet must be designed by a Registered Professional Engineer.
Competent person: the holder of an Annual Permit notifying the District of the commencement of a Trench and/or Excavation project shall designate a competent person.
| Question | Answer |
|---|---|
| Form Name | CAL/OSHA 41-3 |
| Form Length | 2 pages |
| Fillable? | Yes |
| Fillable fields | 78 |
| Avg. time to fill out | 13 min |
| Edition | Rev 11/1/2021 |
| Where to send | Faxed to the nearest DOSH office |
| Matches the agency's file | Yes, checked October 3, 2026 |
| Other names | CAL/OSHA 41-3, Cal/OSHA 41-3, CAL OSHA 41-3, Activity Notification Form, Activity Notification Form for Holders of Annual Permits |
| Official source | CAL/OSHA 41-3 (Rev 11/1/2021), State of California Department of Industrial Relations Division of Occupational Safety & Health |
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