Forms

This flow chart is referenced in FOM Chapter XVI - Administrative File Activities, Appendix D and is regarding the penalty payment/collection process.

Checklist for accident investigations.

Used at the Complaint Desk for accident notifications.

This form is referenced in FOM Chapter III - Inspection Procedures , Appendix C.

This is an alternative PDF form that should be used for equipment calibration.

This is a WORD form which can be used for equipment calibration. Save to your desktop and type information into the form and save the completed...

Case File Summary Sheet.

This Excel spreadsheet incorporates the Coburn Equation to calculate the theoretical airborne concentration of carbon monoxide using the results of...

Checklist for following up with a complainant. Also reference Complaint Evaluation Steps.

Provides the steps for evaluating complaints. Also reference Complaint Evaluation Steps (two page form) and Complainant Follow-up Checklist.

Provides the steps for evaluating complaints. Also reference Complainant Follow-up Checklist and Complaint Evaluation Steps (one page).

This is a new evidence form for compliance officers as part of the paperless processing of investigation files.

This form is referenced in FOM Chapter III - Inspection Procedures, paragraph B.10, Preparation. Information can be typed into this form.

This form should be used when sending contested case file information to the OSH Review Commission by FAX. This form is also linked within/part of FOM...

This form is referenced in FOM Chapter XVI - Administrative File Activities, paragraph E, Contestment. This form should be used when sending contested...

This form should be filled out and mailed to the OSH Review Commission along with the Contested Case Checklist. This form is referenced in FOM Chapter...

DART and DAWFII case rate calculation worksheet.

Form to request IH Technical Equipment Repair from East Compliance Lab. Questions should be directed to Ric Schumann, Lab Supervisor ( ric.schumann...

Form to request IH Technical Equipment Repair from East Compliance Lab. Questions should be directed to Ric Schumann, Lab Supervisor ( ric.schumann...

Fatality notification form used by the Complaint Desk.

Field Sampling Worksheet (WORD Typeover Form).

This form is to be completed for all follow-up assignments. See FOM Chapter II - Compliance Programming, for guidance on the conduct of follow-up...

This table lists the applicability of good faith reductions for administrative violations. Reference FOM Chapter VI - Penalties, paragraph B.9.b.v...

This document is a MS Word version of the heat stress complaint letter, also available in OE.

This letter should be signed by the Bureau Chief and provided to the employer/medical facility/doctor, etc., when the OSH Division has the right to...

This letter should be signed by the Bureau Chief and provided to the employer/medical facility/doctor, etc., when the OSH Division has the right to...

This letter should be signed by the Bureau Chief and provided to the employer/medical facility/doctor, etc., when the OSH Division has the right to...

This letter should be signed by the Bureau Chief and provided to the employer/medical facility/doctor, etc., when the OSH Division has the right to...

HIPAA medical release form to be used for the release of protected health information under HIPAA.

HIPAA medical release form to be used for the release of protected health information under HIPAA. Translated to Spanish 11/29/2023.

HIPAA medical release form to be used for the release of protected health information under HIPAA.

HIPAA medical release form to be used for the release of protected health information under HIPAA. Translated to Spanish 11/29/2023.

This form will be used to document Informal Conference Notes. This form should be maintained in the case file per FOM Chapter XVI - Administrative...

This form will be used to document Informal Conference Notes. This form should be maintained in the case file per FOM Chapter XVI - Administrative...

This questionnaire contains sample employee interview questions and is meant to serve as an investigatory aid for CSHO. It is not part of the...

This questionnaire is intended to serve as an investigatory aid for CSHOs conducting inspections of long term care facilities. It is not comprehensive...

This form is referenced in FOM Chapter III - Inspection Procedures, paragraph D.6.a.ii.F,- Inspection of Records and Posting, for maintaining chain of...

This form is referenced in FOM Chapter III - Inspection Procedures, paragraph D.6.a.ii.F,- Inspection of Records and Posting, for maintaining chain of...

This form is referenced in FOM Chapter III - Inspection Procedures, paragraph D.6.a.ii.E., Cross-referencing Medical Records on Multi-employer...

This form will be used to gather names/next of kin (NOK) information when there is more than one accident or fatality victim.

The North Carolina Department of Labor (NCDOL) is providing notice to employers that may be affected due to a recent change in federal tax law...

The occupation codes and categories listed in this appendix are from the Classified Index of Industries and Occupations developed for the 1980 Census...

This form will be filled out and used to post an imminent danger. This is a WORD typeover file.

This checklist will be used when an employer petitions for modification of abatement. This form is referenced in FOM Chapter XVI - Administrative File...

This checklist will be used when an employer petitions for modification of abatement. This form is referenced in FOM Chapter XVI - Administrative File...

This serves as the official notification of receipt of employer records, including but not limited to documentation, photographs, and video or...

This form serves as the official notification of receipt of employer records, including but not limited to documentation, photographs, and video or...

This form provides chain of custody verification for evidence or property obtained during the course of an OSH investigation. The carbon copy form...

This form is referenced in FOM Chapter III - Inspection Procedures, paragraph D.6.a.iii, Inspection of Records and Posting. This release form should...

This form is referenced in FOM Chapter III - Inspection Procedures, paragraph D.6.a.iii, Inspection of Records and Posting. This release form should...

IRS W-9: Request for Taxpayer Identification Number and Certification. Also reference Notice of IRS Penalty letter.

This form should be used when citations are delivered by hand. This form is also linked in FOM Chapter V - Citations, paragraph H.6., Undelivered...

This form should be used when citations are delivered by hand. This form is also linked in FOM Chapter V - Citations, paragraph H.6., Undelivered...

This webform must be completed to request either the addition of a new SAVE or a correction of an existing SAVE in OSHA Express. Link to webform: http...

Fill out this form and e-mail or fax it to the NCDOL Legal Affairs Division when an attorney contacts you regarding a private civil lawsuit or third...

This form, which is designated VSR 1 and is also included as Appendix III-E to FOM Chapter III - Inspection Procedures, is used to obtain consent from...

This form is referenced in FOM Chapter III - Inspection Procedures, Appendix C. The is a WORD form.

This form is referenced in FOM Chapter III - Inspection Procedures, Appendix C.

This form is referenced in FOM Chapter III - Inspection Procedures, Appendix C.

This form should be used to provide the employer with industrial hygiene sampling results from an inspection.