Osha 160 Form PDF Details

In workplaces across California, ensuring safety and compliance with regulations is paramount. The OSHA Form 160, officially called the Employer's Signed Statement of Abatement of Regulatory and/or General Violations, plays a crucial role in this process. When an inspection or investigation uncovers violations at a place of employment, the law mandates that these issues be rectified within a specified timeframe. The form serves as a vital communication tool between employers and the Department of Industrial Relations' Division of Occupational Safety and Health (DOSH), enabling employers to officially declare that they have addressed the violations noted. It requires detailed information about the corrective measures taken, including specific equipment or procedures implemented, alongside the dates these actions were completed. Additionally, the form emphasizes employer accountability through a signature, certifying the accuracy of the information provided and the completion of the abatement process. This document also outlines the repercussions of failing to submit the form on time, which may include citations and civil penalties. Moreover, it highlights the importance of keeping affected employees and their representatives informed about the abatement activities, ensuring that workplace safety is a transparent and collaborative effort. By completing and returning this form by the due date, employers can possibly avoid a follow-up inspection, streamline their compliance processes, and, most importantly, provide a safer working environment for their employees.

QuestionAnswer
Form NameOsha 160 Form
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namesform cal 160, form signed statement, abatement serious osha form, how to cal osha 160

Form Preview Example

STATE OF CALIFORNIA

1. Return to:

DEPARTMENT OF INDUSTRIAL RELATIONS

 

DIVISION OF OCCUPATIONAL SAFETY AND HEALTH

 

EMPLOYER'S SIGNED STATEMENT OF ABATEMENT OF

REGULATORY AND/OR GENERAL VIOLATIONS

2.EMPLOYER:

ADDRESS:

Street

City

State

Zip

3. The law requires that violations observed during the inspection/investigation completed on

 

 

of the place of employment located at

 

 

be

corrected within the time limit specified. Please notify the Division as soon as these conditions have been corrected by returning this completed form. Your response by completing, signing and mailing this form to the issuing office on or before the compliance date may avoid a follow-up inspection of your facilities. Failure to timely complete and return this form may result in issuance of a citation and civil penalty for violation of 8 CCR 340.4(c).

NOTE: This form does not serve as a request for a time extension. If there are serious problems beyond your control that prevent meeting a specified abatement date, contact the Division early, well within the 15-day limit allowed for an appeal.

4. PLEASE COMPLETE AND MAIL BY

 

200

 

 

 

 

************************

This signed statement or a summary shall be posted for three (3) working days at or near each place the regulatory and/or general violation(s) referred to

in the citation occurred.

5.LIST THE SPECIFIC MEASURES & EQUIPMENT TAKEN TO CORRECT EACH CITATION & ITEM NUMBER OF THE UNSAFE CONDITIONS AND DATE OF ABATEMENT

[ ] Continued on additional page

6.All affected employees and their representatives have been informed about abatement activities referenced in this document

 

in conformance with 8CCR Section 340.4(g). oYes

oNo

 

 

 

 

 

 

 

 

 

 

 

 

7.

This certifies that all the unsafe conditions listed in the Division’s Citation dated

 

 

 

 

 

 

 

 

have now been

 

corrected and all submitted abatement information is accurate.

 

 

 

 

 

 

 

 

 

 

 

 

 

Signature:

 

 

 

 

 

 

 

 

 

 

 

 

Date:

 

 

 

 

 

 

 

Name:

 

 

 

 

 

 

 

 

 

 

 

Title:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

8.

 

 

 

 

 

 

 

 

OFFICE USE ONLY

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Division Engineer/Industrial Hygienist:

 

 

 

 

 

 

 

 

 

 

Date:

 

 

 

 

 

 

 

District Manager:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Date:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

[ ] Close / Comments:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

9.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Region

 

District

 

Inspection No.

 

 

 

ID No.

 

 

 

 

 

Cal/OSHA Rpt.No.

 

 

FY

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

10. Date mailed or delivered:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

CAL/OSHA160(09/01/00)

How to Edit Osha 160 Form Online for Free

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When it comes to fields of this precise PDF, this is what you need to know:

1. Begin completing your abatement citation with a selection of necessary blanks. Consider all of the necessary information and make certain not a single thing left out!

Stage no. 1 of submitting form signed statement

2. Once your current task is complete, take the next step – fill out all of these fields - NOTE This form does not serve as a, This signed statement or a summary, PLEASE COMPLETE AND MAIL BY, in the citation occurred, LIST THE SPECIFIC MEASURES, UNSAFE CONDITIONS AND DATE OF, Continued on additional page, All affected employees and their, in conformance with CCR Section g, This certifies that all the, corrected and all submitted, have now been, Signature, Name, and OFFICE USE ONLY with their corresponding information. Make sure to double check that everything has been entered correctly before continuing!

Filling out section 2 of form signed statement

3. This third stage is normally hassle-free - complete all the empty fields in Division EngineerIndustrial, District Manager, Close Comments, OFFICE USE ONLY, Date, Date, Region, District, Inspection No, ID No, CalOSHA RptNo, Date mailed or delivered, and CALOSHA to conclude this part.

Completing section 3 of form signed statement

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