This request must be received no later than the correction date of the violation listed on the citation.
The address of where the inspection occurred.
The item number of the violation (on the citation) for which an extension is requested.
Any steps being taken to safeguard employees from the cited hazards until correction is completed.
The date the employer proposes to complete the correction.
A statement that a copy of the extension request has been posted as required by state law (437-001-0275).