Form OCC-12 "Public Employees Occupational Safety and Health (Peosh) Unit Request for on-Site Consultation" - New Jersey

What Is Form OCC-12?

This is a legal form that was released by the New Jersey Department of Health - a government authority operating within New Jersey. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on January 1, 2013;
  • The latest edition provided by the New Jersey Department of Health;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of Form OCC-12 by clicking the link below or browse more documents and templates provided by the New Jersey Department of Health.

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Download Form OCC-12 "Public Employees Occupational Safety and Health (Peosh) Unit Request for on-Site Consultation" - New Jersey

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New Jersey Department of Health
Public Employees Occupational Safety and Health (PEOSH) Unit
PO Box 369
Trenton, NJ 08625-0369
Telephone: 609-984-1863
Fax: 609-984-2779
Email: peosh@doh.state.nj.us
REQUEST FOR ON-SITE CONSULTATION
This is a FREE service for New Jersey Public Employers. Employers must correct all serious hazards identified
during the consultation and agree to work with the consultant to develop effective measures for worker safety and
health protection.
For more information or to submit a request contact the PEOSH Unit using the information listed above.
1.
Name of Employer:
Employer Mailing Address:
Employer Telephone Number:
Total Number of Employees (controlled by employer):
2.
Name of Site:
Site Address:
Total Number of Employees at Site (employed at establishment):
Total Number of Employees in the Area(s) of Concern (covered by consultation):
3.
Name of Facility Contact:
Title:
Telephone Number:
4.
What services are you requesting:
5.
Name of Person Requesting
Consultation (Print or Type):
Title:
Telephone Number:
Signature:
Date:
FOR NJDOH USE ONLY
SIC Code
_________________________________
Person Taking Request
________________________
Loc. ID ____________________________________
Date Received
______________________________
Consultation Number
________________________
Consultant Assigned
__________________________
Date Assigned
_____________________________
PEOSH Compliance Activity in Last Twelve (12) Months?
Yes
No
High Hazard
Non-High Hazard
Full Service
Limited Service
OCC-12
JAN 13
New Jersey Department of Health
Public Employees Occupational Safety and Health (PEOSH) Unit
PO Box 369
Trenton, NJ 08625-0369
Telephone: 609-984-1863
Fax: 609-984-2779
Email: peosh@doh.state.nj.us
REQUEST FOR ON-SITE CONSULTATION
This is a FREE service for New Jersey Public Employers. Employers must correct all serious hazards identified
during the consultation and agree to work with the consultant to develop effective measures for worker safety and
health protection.
For more information or to submit a request contact the PEOSH Unit using the information listed above.
1.
Name of Employer:
Employer Mailing Address:
Employer Telephone Number:
Total Number of Employees (controlled by employer):
2.
Name of Site:
Site Address:
Total Number of Employees at Site (employed at establishment):
Total Number of Employees in the Area(s) of Concern (covered by consultation):
3.
Name of Facility Contact:
Title:
Telephone Number:
4.
What services are you requesting:
5.
Name of Person Requesting
Consultation (Print or Type):
Title:
Telephone Number:
Signature:
Date:
FOR NJDOH USE ONLY
SIC Code
_________________________________
Person Taking Request
________________________
Loc. ID ____________________________________
Date Received
______________________________
Consultation Number
________________________
Consultant Assigned
__________________________
Date Assigned
_____________________________
PEOSH Compliance Activity in Last Twelve (12) Months?
Yes
No
High Hazard
Non-High Hazard
Full Service
Limited Service
OCC-12
JAN 13
EMPLOYER OBLIGATIONS AND RIGHTS
Consultative services are provided at no cost to the employer and are supported by Federal and State funds.
The Consultation Program is independent of Federal or State OSHA enforcement. Consultants do not issue
citations or propose penalties. The following information summarizes the employer’s obligations and rights
associated with the consultation process:
Employer Obligations
Employee participation is required on all on-site visits involving hazard identification.
The employer must correct all serious hazards in accordance with mutually agreed upon correction
due dates and provide to the Consultation Project Manager documentation of the action taken to
eliminate or control the hazards. Failure to do so will result in referral to enforcement.
The employer must correct imminent danger situations immediately or remove employees from the
danger area. Failure to remove employees from an imminent danger area will result in immediate
referral to enforcement.
The employer must agree to post the List of Hazards, as it was received from the Consultation
Project, for either 3 working days or until the hazards identified on the list are corrected, whichever is
later.
No consultation visit may take place while an enforcement inspection is in progress [i.e., from the time
the compliance officer initially seeks entry into the workplace till enforcement inspection activity at the
worksite is final, and any cited item(s) have become final orders].
The employer may be exempt from programmed enforcement inspections for a period of two years if
that employer satisfies all of the conditions required to participate in an exemption program such as
the Safety and Health Achievement Recognition Program (SHARP). Contact the Consultation Project
Manager for more information on this program.
Employer Rights
The employer has the right to modify the scope of the visit or terminate participation in the visit at any
time, including termination of the hazard survey before its completion. The employer is responsible for
correcting any serious hazards identified up to the point of termination and except in situations where
imminent danger or serious hazards are not corrected as agreed upon, the employer's name and the
results of the onsite visit will remain confidential.
The employer has the right to disagree with the correction schedules and may, within 15 working
days of receipt of the Written Report to the Employer, appeal to the Consultation Project Manager for
amendment of the correction date(s) or any other substantive findings of the Report. Disagreement
over or amendment of the correction schedule or report findings does not relieve the employer of the
responsibility to correct serious hazards identified.
If an enforcement inspection occurs after the conclusion of the consultation visit, the employer is not
required to inform the PEOSH compliance officer of the consultation onsite visit or furnish a copy of
the results, except to the extent that disclosure of information contained in such a report is required
by 29 CFR 1910.1020 (Access to Employee Exposure and Medical Records) or other standards. The
other exceptions would be failure to eliminate imminent danger and failure to eliminate serious
hazards.
The employer has the right to request a private meeting with the consultant to discuss matters that he
or she may wish not to discuss in the presence of the employee representative.
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