Fillable Appeal to the Boiler and Pressure Vessel Board (Office of the Chief Information Officer)

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Appeal to the Boiler and Pressure Vessel Board (Office of the Chief Information Officer)

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BROWSE OFFICE OF THE CHIEF INFORMATION OFFICER (IA) FORMS

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Appeal to the Boiler and Pressure Vessel Board
Notice: This document affects your legal rights. You may wish to consult an attorney
before completing this document. For more information, please read the boiler board’s rules
on contested cases at 875 Iowa Administrative Code Chapter 84.
Your name: _____________________ Your title: ______________________________
Name of the organization you represent, if applicable: ___________________________
Your phone number: ______________ Your e-mail address: _____________________
Your address: ___________________________________________________________
Was a Petition for Reconsideration of an Inspection Report timely filed with the Labor
Commissioner? If not, you must do so before you can file an appeal with the board.
Yes No
Did the Labor Commissioner deny your Petition for Reconsideration?
Yes Date of denial: __________ No
Boiler or pressure vessel location: __________________________________________
Boiler or pressure vessel State ID No.: ______________________________________
Inspection date: _______________ Inspector’s name: ________________________
What is the basis for your appeal? Please state the findings and conclusions you are
challenging. (Attach other pages and copies of related documents.)
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04-07
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Types of review. Appeals may begin with an informal review by the board followed by the
option for a formal review. Or, appeals may begin with a formal review.
Informal Review. If you request it and the board considers it appropriate, the board may
grant an informal review. Informal review is only available if you waive below the right to
seek disqualification of a board member based on the board member’s participation in the
informal review. You would retain the right to seek disqualification of a board member on
other grounds. You can request to proceed with a formal contested case proceeding within
10 days after the informal proceeding.
Formal Review. You have the right to choose to participate in a formal contested case
proceeding
I wish to participate in a formal contested case proceeding.
I wish to request participation in an informal review by the board and hereby
voluntarily elect to waive the right to seek disqualification of a board member based
solely on the board member’s participation in the informal review.
Mail this form with copies of the Inspection
Report, Petition for Reconsideration, Denial
of Petition for Reconsideration, and
information you want the board to consider
to:
Boiler and Pressure Vessel Board
Iowa Division of Labor
1000 East Grand Avenue
Des Moines, Iowa 50319-0209
_____________________________
Your signature
_____________________________
Date
04-07
2
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Appeal to the Boiler and Pressure Vessel Board (Office of the Chief Information Officer)

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Completed 13 August 2020

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