Application to obtain intervenor status

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.

Occupational Health and Safety Tribunal Canada

Tribunal de santé et sécurité au travail Canada

Arms of Canada

Ottawa, Canada K1A 0J2

Application to obtain intervenor status

Case number (if known):

The appeal

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 (if applicable):

Name of organization representing the respondent (if applicable):

Name and title of the respondent’s representative (if applicable):

Information about the applicant

Name:

Contact person and title:

Email address:

Phone number:

Name of organization representing the applicant (if applicable):

Name and title of the applicant’s representative:

Email address:

Phone number:

Criteria for intervenor status

Attach additional pages if necessary.

Explain your interest in the appeal and describe your position:

Explain how your intervention will assist the appeals officer in making his decision:

Explain whether the public interest and those of justice necessitate the intervention:

Signature of applicant:

Date:

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
Email: registrar-registraire@ohstc-tsstc.gc.ca
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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