Application for a stay of a direction issued by an official delegated by the Minister of Labour
The HTML version of this application form is presented as an example only. To fill out and print an Application to Appeal please use the PDF Version.
Identify the direction(s) you are appealing and applying to stay.
Case number (if known):
Name of Minister of Labour’s delegate who issued the direction:
Name of the appellant:
Name of organization representing the appellant (if applicable):
Name and title of the appellant’s representative (if applicable):
Name of the respondent:
Name and title of the respondent’s representative (if applicable):
Ground for the application to stay the direction
The applicant may submit this form at same time as the Notice of Appeal or at a later date. Attach additional pages if necessary.
Explain briefly why your appeal should succeed:
Explain how the appellant would likely suffer significant harm if the appeals officer did not grant the stay. Attach any documents needed to support your explanation:
Explain the measures that will be put in place to protect the health and safety of employees or any other persons granted access to the work place should the stay be granted:
Signature of applicant:
Name of signatory:
Total number of pages submitted:
Please include a copy of the decision(s) or direction(s) if available
200-47 Clarence Street, Ottawa ON K1A 0J2
Occupational Health and Safety Tribunal Canada
Telephone number: 613-437-0612 or 1-866-440-3343 / Facsimile number: 613-437-0600
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