Notice of appeal of a decision following a group work refusal

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Occupational Health and Safety Tribunal Canada

Tribunal de santé et sécurité au travail Canada

Arms of Canada

Ottawa, Canada K1A 0J2

Subsection 129(7) of the Canada Labour Code
Notice of appeal of a decision following a group work refusal

Nature of the appeal

Appeal of a decision that a danger does not exist

[yes/no]

Appeal of a decision that the danger is a normal condition of employment

[yes/no]

Appeal of a decision that the refusal puts the life, health, or safety of another person directly in danger

[yes/no]

Spokesperson

Please complete the attached List of Group Appellants

Full Name:

Title:

Email address:

Phone number:

Representation

You may appoint one person or an organization to represent you or choose to represent yourself. Please fill in the section below if you will have a representative.

Name of organization:

Name and title of contact person:

Email address:

Phone number:

Information about the respondent

Name of employer:

Contact person and title:

Email address:

Phone number:

Information about the decision

Name of Minister of Labour’s delegate who rendered the decision:

Date of the decision:

Location of work place (city, province):

Reasons for the appeal

Briefly explain why you believe the Official’s decision is not well founded. Attach additional pages if necessary

Signature of spokesperson or representative:

Date:

Signature:

Name of appellant Phone Email address
     
     
     
     
     
     
     

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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