OSHA Informal Settlement Agreement

Agreement Identification

Agreement Date: [__/__/____]

OSHA Inspection Number: [________________________________]

OSHA Area Office: [________________________________]

Parties to Agreement

The Secretary of Labor

Represented by:

OSHA Area Director: [________________________________]

Address: [________________________________]

City, State, ZIP: [________________________________]

Phone: [________________________________]

Email: [________________________________]

The Employer

Company Name: [________________________________]

DBA (if applicable): [________________________________]

Address: [________________________________]

City, State, ZIP: [________________________________]

Federal Employer ID (FEIN): [________________________________]

Phone: [________________________________]

Email: [________________________________]

Represented By:

Name: [________________________________]

Title: [________________________________]

Attorney (if applicable): [________________________________]

Inspection Information

Inspection Site: [________________________________]

Address: [________________________________]

City, State, ZIP: [________________________________]

Date(s) of Inspection: [__/__/____] to [__/__/____]

Date Citation Issued: [__/__/____]

Date Citation Received: [__/__/____]

CSHO Name: [________________________________]

Original Citation Summary

The following citations and proposed penalties were originally issued:

Total Original Proposed Penalties: $[________________________________]

Settlement Terms

Article I: Amended Citations

The parties agree that the original citation(s) shall be amended as follows:

Article II: Withdrawn Citations

☐ The following citation item(s) are hereby WITHDRAWN:
- Citation/Item: [________________________________]
- Citation/Item: [________________________________]
- Citation/Item: [________________________________]

☐ No citations are being withdrawn.

Article III: Affirmed Citations

☐ The following citation item(s) are AFFIRMED as originally issued or as amended above:
- Citation/Item: [________________________________]
- Citation/Item: [________________________________]
- Citation/Item: [________________________________]
- Citation/Item: [________________________________]

Penalty Settlement

Article IV: Amended Penalties

The penalties are hereby amended as follows:

Total Original Penalties: $[________________________________]

Total Amended Penalties: $[________________________________]

Total Penalty Reduction: $[________________________________]

Percentage Reduction: [____]%

Article V: Payment Terms

The Employer agrees to pay the total amended penalty amount of $[________________________________] according to the following terms:

☐ Lump Sum Payment
- Full amount due within [____] days of execution of this Agreement
- Payment due date: [__/__/____]

☐ Installment Payments

Payment Method: [________________________________]

Make Payment To: [________________________________]

Mail Payment To: [________________________________]

Payment Reference Number: [________________________________]

Abatement Requirements

Article VI: Abatement Dates

The abatement dates are established as follows:

Article VII: Abatement Measures

The Employer agrees to implement the following specific abatement measures:

Citation/Item [____]:
- Required Action: [________________________________]
- Method of Abatement: [________________________________]
- Completion Deadline: [__/__/____]
- Documentation Required: [________________________________]

Citation/Item [____]:
- Required Action: [________________________________]
- Method of Abatement: [________________________________]
- Completion Deadline: [__/__/____]
- Documentation Required: [________________________________]

Citation/Item [____]:
- Required Action: [________________________________]
- Method of Abatement: [________________________________]
- Completion Deadline: [__/__/____]
- Documentation Required: [________________________________]

Article VIII: Abatement Certification

The Employer agrees to submit written certification of abatement to the Area Director within [____] days of completing each abatement action, including:

☐ Description of abatement action taken
☐ Date hazard was eliminated or controlled
☐ Photographs documenting abatement (where applicable)
☐ Documentation of any equipment installed or modified
☐ Training records (where applicable)
☐ Updated written programs (where applicable)

Additional Settlement Terms

Article IX: Additional Employer Commitments

The Employer further agrees to:

☐ Training Requirements:
[________________________________]
[________________________________]

☐ Program Development/Revision:
[________________________________]
[________________________________]

☐ Equipment Modifications/Installations:
[________________________________]
[________________________________]

☐ Third-Party Consultation/Audit:
[________________________________]
[________________________________]

☐ Other Commitments:
[________________________________]
[________________________________]

Article X: Monitoring and Verification

☐ OSHA may conduct a follow-up inspection to verify abatement
☐ The Employer agrees to submit periodic progress reports
☐ The Employer agrees to provide access to documentation upon request

General Provisions

Article XI: No Admission of Liability

☐ This Agreement constitutes a compromise settlement and does not constitute an admission by the Employer of any violation of the Occupational Safety and Health Act of 1970 or any standard, rule, or regulation promulgated thereunder.

☐ The Employer admits to the violations as cited and amended herein.

Article XII: Posting Requirements

The Employer agrees to post this Informal Settlement Agreement, or a copy thereof, alongside the amended citation(s) at or near the location where the original citation(s) were required to be posted, and to provide a copy to any authorized employee representative.

Article XIII: Final Order

Upon execution of this Agreement and payment of the agreed penalty:

☐ The citation(s), as amended herein, shall become a final order of the Occupational Safety and Health Review Commission.

☐ The Employer waives any right to contest the citation(s) and penalty(ies) as amended herein.

☐ This Agreement shall not be cited as a "history" of violations for purposes of proposing penalties in future inspections, except as required by law.

Article XIV: Failure to Abide by Agreement

The Employer understands that failure to comply with the terms of this Agreement, including:
- Failure to pay the agreed penalty by the due date(s)
- Failure to complete abatement by the agreed date(s)
- Failure to submit required documentation

May result in additional enforcement action, including but not limited to:
- Issuance of notification of failure to abate
- Assessment of daily penalties
- Referral for collection

Article XV: Entire Agreement

This Agreement constitutes the entire agreement between the parties regarding the citation(s) and proposed penalty(ies) referenced herein. No other agreements, understandings, or representations, written or oral, shall be binding unless expressly incorporated herein.

Article XVI: Modification

This Agreement may not be modified except by written agreement signed by both parties.

Article XVII: Governing Law

This Agreement shall be governed by and construed in accordance with the Occupational Safety and Health Act of 1970 and the regulations promulgated thereunder.

Execution

Certification of Timely Execution

☐ This Agreement is being signed prior to the expiration of the 15 working day contest period.

Date of citation receipt: [__/__/____]

15 working day deadline: [__/__/____]

Date of Agreement signature: [__/__/____]

Employer Signature

The undersigned, being duly authorized to act on behalf of the Employer, has read and understands this Agreement and agrees to be bound by its terms.

Signature: _________________________________

Printed Name: [________________________________]

Title: [________________________________]

Company: [________________________________]

Date: [__/__/____]

Witness (if required):

Signature: _________________________________

Printed Name: [________________________________]

Date: [__/__/____]

OSHA Signature

OSHA Area Director:

Signature: _________________________________

Printed Name: [________________________________]

Title: Area Director

OSHA Area Office: [________________________________]

Date: [__/__/____]

Attachments

☐ Amended Citation(s)
☐ Original Citation(s)
☐ Payment Schedule (if applicable)
☐ Abatement Plan
☐ Training Plan
☐ Other: [________________________________]

Distribution

Copy to:
☐ Employer (original)
☐ OSHA Area Office (original)
☐ Regional Solicitor's Office
☐ Employee Representative (if applicable)
☐ Inspection file

Sources and References

• 29 CFR 1903.20: Informal conferences
• 29 CFR 2200.100: Settlement (OSHRC Rules)
• 29 CFR 2200.120: Settlement procedure (OSHRC Rules)
• OSHA Field Operations Manual, Chapter 7 and Chapter 8
• CPL 02-00-163: OSHA Field Operations Manual