Laserfiche WebLink
<br />t <br /> <br />COMPLETE AND RETURN THIS FORM WITHIN 30 DAYS <br /> <br />-.= <br /> <br />OStlCi <br /> <br />DEPARJ",IE.4T CF LA.eCR AND fNOlJSTW <br /> <br />Return to: <br /> <br />Telephone: <br />Fax: <br /> <br />MAND/\. TORY PROGRESS REPORT <br /> <br />Minnesota.,q,Srj Division <br />443 Lafayett,tRoad <br />St. Paul, Minr..esota 55155 <br />~g~ <br />651/284"50501 <br />651/297.2527 <br /> <br />For Office Use Only <br />OComplete <br />Olncompletc <br />OExtension Request <br /> <br />In accordance with MN Ru[e 5210.0532, this report MUST be returned to the Area Office designated above. Failure to <br />submit all required progress repo;:t'~,\^{_iiF'~esult in an additional citation I penalty, and/or follow-up inspection. The complete <br />""......1 <br />Progress Report Form is to be ma11e,"((:by the latest abatement date on the -citationr or within 30 days after receipt of the <br />citation, whichever is earlier. Addjtj"~h'al reports {if necessary} are to be sent at 30 day intervals until all items have been <br />'0'-1 -_,"., <br />fu[lyabated. ..i" '~'.. <br /> <br />From; Company Name <br />Company Address <br />City, State Zip <br /> <br />, <br />Right-to-Know program written ~ 7/21 <br />a. MSOSs consolidated; missing MSOSs requested from'mfrs 8/10 <br />b, training program updated and being conducted by department 8/10 <br />c. training records updated; maintenance system established 7/21 <br />d. training will be conducted for all new employees upon hire ~ 7/21 <br />~1~ <br />Respirator removed from work area and no longer available for. ~ 7/21 <br />use; written respirator program no longer required. ~!~ "",",,,,,,,",, <br />NOTE: If the anticipated completion date is beyond the date by which the alleged violation must be abated, you must <br />submit a separate written Petition for Modification of Abatement Date (PMAl to request an extension of time allowed for <br />completion. See instructions tor a PMA on page 2 of the Citation and Notification of Penalty_ <br />, . . '@lC",,!::;::t:t;i' <br />~ <br />A copy of this Progress Report must be posted for 15 days where the citation and notit.ication of penalty is posted and all <br />affected employees and their representatives must be informed of their right to examiril'~N~d' copy all abatement <br />documents submitted to the Commissioner. ~~~nm:;:i~:~ <br /> <br />Jobsite: <br /> <br />Citation <br />and Item <br />No. <br /> <br />1.1 <br /> <br />1-2 <br /> <br />1.3 <br /> <br />2-1 <br /> <br />2.2 <br /> <br />Inspection No. 300000000 <br />aSH! ID: S9999 <br />Optional Report No. 001.98 <br /> <br /> <br />FilL IN ONE <br /> <br />Action Taken <br /> <br /> <br />Abatement <br />Date on <br />Citation <br /> <br />Date <br />Abated <br />(Corrected) <br /> <br />Antic! <br />Completion <br />Date {See No tel <br /> <br />~,,;, f~f! <br />!"'~~.."<:?~"'.'...\;':' .r~ ~d <br />I';" ", (i) i~B <br />~~ -":~;' /\'/ M:J <br />Safety goggle eye protection has been p"rovided to' workers in <br />,~:j''''V!\;If ".~~ <br />washer area_ '~'I ~I!..' :r~ <br /> <br />7110 <br /> <br />7/6 <br /> <br />Fan removed from site; no longer available for use. <br /> <br />7110 <br /> <br />7/3 <br /> <br />Shower/eyewash station installed <br /> <br /> <br />8/2 <br /> <br />811 0 <br /> <br />7/17 <br /> <br />9/1 <br />9/1 <br /> <br />7/17 <br />711 7 <br /> <br />7/3 <br /> <br />. <br /> <br />I hereby certify that this information is accurate. <br /> <br />I Completed by: <br />Telephone: <br /> <br />Title: <br /> <br />Date: <br />