Notice of appeal

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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

Subsections 129(7) or 146(1) of the Canada Labour Code
Notice of appeal

I wish to appeal a decision regarding a refusal to work:

That a danger does not exist

[yes/no]

That the danger is a normal condition of employment

[yes/no]

That the refusal puts the life, health or safety of another person directly in danger

[yes/no]

I wish to appeal a direction

[yes/no]

I wish to apply for a stay of the direction

[yes/no]

(Please complete the Application for a stay of a direction issued by an official delegated by the Minister of Labour form)

Appellant:

Name of representative:

Address:

Telephone number:

Email address:

Respondent:

Name of the official delegated by the Minister of Labour who rendered the decision(s) or direction(s):

Date of decision(s) or direction(s):

Reasons for appeal:

(Attach additional pages if necessary)

Date:

Signature:

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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