experimental_variance_app_checklist

Experimental Variance Application Checklist
Use of this checklist can assist applicants to determine if an application for an
experimental variance is complete and appropriate.
Does the written application contain the following information?

Applicant Information

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Yes

Name and address of the applicant company.

Yes

Name of, and contact method for, the applicant’s authorized representative
and primary point of contact (if different from authorized representative).

Yes

NA

Address of place or places of employment involved (for multiple sites).

Support Information

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❏
❏
❏

Yes

List of the OSHA standard(s) from which the applicant is requesting
the experimental variance.

Yes

Detailed explanation of why the proposed experimental variance is necessary,
and a description of the risks and hazards associated with the experiment and
how the applicant will provide an equivalent level of protection to workers
during the experiment.

Yes

Detailed explanation of how the experimental variance will demonstrate or
validate new and improved techniques to safeguard the health and safety of workers.

Yes

Detailed description of the proposed experiment, which must include:

❏
❏

Yes

Names and qualifications of the supervisor(s) of the experiment,
and the supervisor’s(s’) staff involved in the experiment; and

Yes

Proposed steps and duration of the experiment (in days), employee
work time (in hours), and hours of machine operation (if applicable).

❏

Yes

Detailed statement describing similar experimentation or related research
conducted by the applicant or another party (if known). The statement should
include, if available, data, summaries, reports, and evaluations (or a reference
thereto) of such experimentation or research.

❏

Yes

Statement that demonstrates that the applicant has sufficient technological,
economic, and labor resources to perform the experiment properly, with
proper controls.

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Yes

Yes

NA

Signed letter or an official document indicating approval of the experiment by
the Secretary of the U.S. Department of Health and Human Services (if available).
Copy of a written statement(s) signed by each employee who agrees to participate
in the proposed experiment that he/she does so knowingly, willingly, and voluntarily.
Certification that the applicant informed the employees volunteering to participate in
the experiment of the plan of the proposed experiment, its attendant risks, their right
to terminate participation in the experiment, and their right to petition the Assistant
Secretary for a hearing, by using one or more of the means identified below:

❏

Yes

Giving a copy of the experimental variance application to the authorized
employee representative(s), and providing instructions concerning the
employees’ right to petition the Assistant Secretary for a hearing;

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Yes

Posting a statement where the applicant normally posts notices to
employees giving a summary of the variance application and specifying
where its employees may examine a copy of it, and providing instructions

concerning the employees’ right to petition the Assistant Secretary for a
hearing (or, instead of a summary, posting the application itself); and

❏

Yes

If the applicant used an alternate means (other than the means specified
in statements (a) and/or (b) above) to inform its employees of the
application and their right to petition the Assistant Secretary for a hearing,
then providing a detailed description of the alternate means used.

If the variance application involves one (or more) states covered by Federal OSHA,
and one (or more) State Plan state(s),1 the application provides the following
information for each standard from which the applicant is requesting the
experimental variance:

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Side-by-side comparison of the OSHA standard(s) and the state
standard(s) that is/are identical to the OSHA standard;2

Yes

Statement certifying that the applicant has not filed an application for
an experimental variance on the same material facts for the same place(s)
of employment with the State Plan state/states in question; and

Yes

Statement identifying any pending citations issued to the applicant by a
State Plan state for violating the state standard(s) that is/are the subject of
this variance application.

Statement describing in detail any:

Yes

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Yes

Yes

Past or pending citations, including identification and the disposition
thereof, issued to the applicant by Federal OSHA or a State Plan state; and

Yes

Judicial and administrative proceedings to which the applicant is or was a
party involving breaches of the Occupational Safety and Health Act of 1970,
or violations of standards or regulations issued by Federal OSHA or a
State Plan state.

Signed certification that the information contained in the application is accurate and
true to the best of the applicant’s knowledge.

Yes

Appropriateness of the Variance Application
A “Yes” response to any of the items below indicates that the application may not be appropriate:

❏ ❏
Yes

No

The variance the applicant is requesting is from a “performance” standard, which is
one that does not specify methods or actions that the employer must implement to
meet the requirements of the standard.

❏ ❏
Yes

No

The variance the applicant is requesting is from a “definition” in a standard.
Definitions are not enforceable portions of a standard since they do not specify means,
methods, or actions the employer must implement for meeting the requirements of
the standard.

❏ ❏
Yes

No

The application requests an exemption or waiver from the requirements of
the standard.

❏ ❏

No

The variance is a request for review and approval of a design or product developed
for manufacture and commercial use.

Yes

The following are states and territories with approved state plans: AK, AZ, CA, CT,* HI, IA, IL,* IN, KY, MD, MI,
MN, NC, NJ,* NM, NV, NY,* OR, PR, SC, TN, UT, VA, VT, VI,* WA, and WY. *Plans cover public-sector employees
only; the remaining states cover both public- and private-sector employees.
2 If the state standard(s) is/are not identical to the OSHA standard(s), the applicant must apply to the state for an
experimental variance.
1

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Yes

No

There exists an OSHA letter of interpretation that governs the acceptability of
the requested alternative.

Yes

No

There is an updated edition of the nationally recognized consensus standard upon
which OSHA based the standard that is the subject of the variance request, and the
updated consensus standard permits the requested alternative (and that protects
employees at least as effectively as the OSHA standard).

❏ ❏

No

The application involves workplace locations that are solely in State Plan states.

Yes