OPD 870
Effective May 2005
| Contractor/Subcontractor **insert name and mailing address of employer concerned** |
Work site **insert worksite name and address/location** |
| Contact **insert contractor/subcontractor contact name and telephone #** | |
Subsequent to an ****inspection OR investigation**** by HRSDC – Labour Program on **date of intervention**, the following actions are required to fulfil the "Labour Conditions" of the above noted contract:
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Action No.
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Action
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Completion Date
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I, the undersigned employer or employer's representative, hereby declare that I have read this document and understand what action is required, agree to take such action and to have it completed on or before the completion date indicated above, and agree to inform, in writing, the inspector named below, within five (5) days from the above completion date, that the remedial action has been taken or submit an action plan with time frames.
|
______________________________________
Contractor |
_____________________
Date |
|
______________________________________
Inspector **sign and print inspector's name** **insert mailing address of inspector** |
Labour Reference No. – **assignment #**
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| ** | Where input is necessary |
| **** | Use one OR the other possibility given in between the asterisks |