OSHA Form 5-30-2 TemporaryVariance Application

TEMPORARY VARIANCE APPLICATION

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OMB Control Number: 1218-0265
Expires: 3/31/2025

Instructions: Please review the supplemental information and instructions Supplemental Information and Completion
Instructions prior to completing the variance application. For questions about this form or the variance process, contact OSHA
at [email protected]
Section I - Applicant Information

1. Applicant Company
Company Name:
Principal Address:
Street:
City:

State:

ZIP Code:

State:

ZIP Code:

2. Contact Information
a. Authorized Representative:
Company Representative's Name:
Title/Position:
Address (if different from the company's principal address):
Street:
City:
Telephone:

Fax:

Email:

b. Primary point of contact with the company (if different from the authorized representative):
Point of Contact Name:
Title/Position:
Address (if different from the company's principal address):
Street:
City:
Telephone:

Fax:

State:

ZIP Code:

State:

ZIP Code:

State:

ZIP Code:

State:

ZIP Code:

Email:

3. Multiple Site Addresses
a. Site Name:
Site address including:
Street:
City:
b. Site Name:
Site address including:
Street:
City:
c. Site Name:
Site address including:
Street:
City:
1Use of this form is voluntary.

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OSHA Form 5-30.2
June 2011

Section II - Support Information
4. List the newly published OSHA standard(s) from which the applicant is requesting the temporary variance.

5. Provide a statement of when the applicant expects to be able to comply with the standard(s), and describe in detail what steps the
applicant has taken and will take (during the period of the temporary variance), with specific dates when appropriate, to come into
compliance as quickly as possible with the new standard(s) from which the applicant is requesting the temporary variance.

6. Select one or more of the condition(s) specified below to describe why the applicant was unable to comply with the new standard(s) by
its/their effective date:
a. Unavailability of technical or professional personnel. (Explain in detail.)

b. Unavailability of material and/or equipment. (Explain in detail.)

c. Inadequate time allowed to complete the necessary construction or alteration of facilities. (Explain in detail.)

7. Provide the names, occupations, and contact information of qualified person(s) who can confirm the applicant's explanation and
assertion that it is unable to comply with the new standard(s) by its/their effective date.

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OSHA Form 5-30.2
June 2011

8. By the signature entered below, the applicant certifies that it:
a. Is taking all available steps to safeguard its workers against the hazards covered by the standard(s); and
b. Has an effective program for coming into compliance with the standard(s) as quickly as possible.
Attach a detailed description of the steps taken to safeguard workers against the hazards covered by the standard.
9. By the signature entered below, the applicant certifies that it informed its employees of the variance application and of their right to
petition the Assistant Secretary for a hearing by using one or more of the means described below (place a check mark identifying the
means selected):
a. Giving a copy of the temporary variance application to the authorized employee representative(s);
b. Providing instructions to its employees concerning their right to petition the Assistant Secretary for a hearing;
c. Alternatively, posting a statement giving a summary of the application, informing employees of their right to petition the
Assistant Secretary for a hearing, and specifying where its employees may examine a copy of the temporary variance
application (at the place(s) where the applicant normally posts notices to employees or, instead of a summary, posting
the application itself).
d. If the applicant used an alternate means (other than the means specified in the statements (a), (b) and/or (c) above)
to inform its employees of the application and their right to petition the Assistant Secretary for a hearing, then attach
a detailed description of the alternate means.
10. If the variance application involves one (or more) states covered by Federal OSHA, and one (or more) State Plan state(s),2 provide the
following information for each standard from which the applicant is requesting the temporary variance:
a. A side-by-side comparison of the OSHA standard(s) and the state standard(s) that is/are identical to the OSHA standard;3

b. A statement certifying that the applicant has not filed an application for a temporary variance on the same material facts for the
same place(s) of employment with the State Plan state/states in question; and

c. A 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.

11. By the signature below, the applicant certifies that the status of any outstanding State Plan state citation(s) as follows (place a check
mark next to the item describing the current status):
a. The applicant is not contesting any citations involving the standard(s) that is/are the subject of this application.
b. The applicant is taking measures to abate this/these citation(s).
c. The applicant is contesting a citation involving the standard in question.

2The 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-sector and private-sector
employees.
3If the state standard(s) is/are not identical to the OSHA standard(s), the applicant must apply to the state for an temporary variance.

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OSHA Form 5-30.2
June 2011

12. If the applicant is requesting an Interim Order to use the alternative method until OSHA renders a decision on the temporary variance
application, attach a statement of facts and argument explaining why OSHA should grant such an Order.
13. The applicant certifies by the signature below that the information contained in the application is accurate and true to the best of the
applicant's knowledge.

Signature of the authorized representative:
Print name:

Date:

Paperwork Reduction Act Statement

OMB Control Number: 1218-0265

According to the Paperwork Reduction Act of 1995, no person is required to respond to a collection of
information unless such collection displays a valid OMB control number. Public reporting burden for this
collection of information is estimated to average 30 hours per response. This burden includes locating and
assembling information required to complete the variance application, informing affected workers of the
decision to seek a variance, completing the variance application, and assembling the application
documents, but does not include hosting an OSHA site visit. The obligation to respond to this collection is
voluntary. Information obtained from this form will be used to determine if a variance will be granted to
the applicant. Send comments regarding the burden estimate or any other aspect of this collection of
information, including suggestions for reducing this burden, to: U.S. Department of Labor, OSHA, Office
of Technical Programs and Coordination Activities, Room N-3653, Frances Perkins Building, 200
Constitution Avenue, N.W., Washington, D.C. 20210. OMB Control Number: 1218-0265.

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OSHA Form 5-30.2
June 2011

Supplemental Information and Instructions for Completing the
Temporary Variance Application
Section 6(b)6(A) of the Occupational Safety and Health (OSH) Act of 1970 (29 U.S.C. 651 et seq.) authorizes
temporary variances from Occupational Safety and Health Administration (OSHA) standards. Employers may apply
for a temporary variance by following the regulatory requirements specified by 29 CFR 1905.10. Sections A, B, C,
and D below provide a brief summary of these requirements, detailed instructions for completing the application form,
some common application deficiencies to avoid, and procedures and instructions for submitting a temporary variance
application to OSHA.
A. Summary of Requirements for Obtaining a Temporary Variance
An employer (or class or group of employers4) may request a temporary variance for a specific workplace(s). A
temporary variance authorizes an employer short-term (i.e., limited time) relief from a standard when the employer
cannot comply with newly published OSHA requirements by the prescribed effective date because the necessary
construction or alteration of the facility cannot be completed in time, or when technical personnel, materials, or
equipment are temporarily unavailable. To be eligible for a temporary variance, an employer must implement an
effective compliance program as quickly as possible. In the meantime, the employer must demonstrate to OSHA
that it is taking all available steps to safeguard workers. Inability to afford the cost of complying with the
standard is not a valid reason for requesting a temporary variance. In addition, the employer must notify
employees of the variance application, and of their right to participate in the variance process.
B. Instructions for Completing the Temporary Variance Application
Section I: Application Information
1. and 2. Self-explanatory.
3. Provide the address(es) of all the location(s) of employment where the applicant would implement the temporary
variance (if different from the company's principal address).
Section II: Support Information
4. through 7. Self-explanatory.
8. Provide certification as indicated that the applicant:
a. Is taking all available steps to safeguard its workers against the hazards covered by the standard(s); and
b. Has an effective program for coming into compliance with the standard(s) as quickly as possible.
Attach a detailed description of the steps taken to safeguard workers.
9. Provide certification as indicated that the applicant informed its employees of the variance application and their right
to petition the Assistant Secretary for a hearing by using one or more of the means selected from the list:
a. Giving a copy of the temporary variance application to the authorized employee representative(s);
b. Providing instructions to its employees concerning their right to petition the Assistant Secretary for a hearing;
c. Alternatively, posting a statement giving a summary of the application, informing employees of their right to
petition the Assistant Secretary for a hearing, and specifying where its employees may examine a copy of the
temporary variance application (at the place(s) where the applicant normally posts notices to employees, or
instead of a summary, posting the application itself); and
4A class or group of employers in the same industry (such as members of a trade alliance or association) may apply jointly for a variance
provided an authorized representative for each employer signs the application and the application identifies each employer's affected facilities.

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OSHA Form 5-30.2
June 2011

d. If the applicant used means other than the means specified in statements (a), (b), and/or (c) to inform its
employees of the application and their right to petition the Assistant Secretary for a hearing, attach a detailed
description of such alternate means.
10.
a. Self-explanatory.
b. A statement certifying that the applicant has not filed an application for a temporary variance on the same
material facts for the same place(s) of employment with the State Plan state/states in question; and
c. Self-explanatory.
11. and 12. Self-explanatory.
13. This form is to be signed by the applicant's authorized representative to certify that the information contained in the
application is accurate and true to the best of the applicant's knowledge. Also, enter the printed name of the applicant's
authorized representative and the date the authorized representative signed the application.
C. Reviewing the Temporary Variance Application
Carefully review the variance application, and ensure that:
1. The application is complete and contains detailed descriptions for each item in the form, including the name and
signature of the authorized representative;
2. The applicant is not seeking the variance from a "definition" or from a "performance" standard (i.e., a standard that
does not describe a specific action for meeting the requirements of the standard);
3. The applicant submits the application to OSHA prior to the date that the new standard in question goes into effect;
and
4. If the application involves location(s) in State Plan states, that it also includes a state or states under Federal OSHA
authority.5
D. Procedure for Submitting a Temporary Variance Application
Applicants must use the following procedure when completing and submitting an application for a temporary
variance to OSHA:
1. Complete this Temporary Variance Application form (printed or saved from OSHA's Variance Web site),
or develop their version of the application that meets the regulatory requirements of 29 CFR 1905.10.
2. If completing a printed copy of the application form, use additional sheets when necessary to provide a full
and detailed response.
3. The employer, or an authorized representative of the employer, must sign the completed variance application.
4. Submit the original of the completed application, as well as other relevant documents,6 to:
5Private-sector employers in the following states and territories are under Federal OSHA authority for occupational safety and health purposes:
AL, AR, CO, CT, DC, DE, FL, GA, ID, IL, KS, LA, MA, ME, MO, MS, MT, ND, NE, NH, NJ, NY, OK, OH, PA, RI, SD, TX, WI, and WV. Territories:
American Samoa, Guam, Trust Territory of the Pacific Islands, Virgin Islands, and Wake Island.
Most private-sector employers in the following 22 states and territories are under the authority of an OSHA-approved state occupational safety
and health plan (State Plan states): AK, AZ, CA, HI, IA, IN, KY, MD, MI, MN, NC, NM, NV, OR, SC, TN, UT, VA, VT, WA, and WY. Territory: PR.
Addresses for these states are available on the OSHA web site at www.osha.gov. (These states and territory, as well as CT, IL, NJ, NY, and VI, also
provide coverage to public-sector employers under their state plans. Public-sector -- state and local government -- employers must apply to the
applicable state for a variance.)
6Other documents may include photos, blueprints, drawings, models, reports, data, and other information and evidence necessary to describe
the proposed alternative, and to demonstrate the level of employee protection it provides.

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OSHA Form 5-30.2
June 2011

By regular mail:
Assistant Secretary for Occupational Safety and Health
Director, Office of Technical Programs and Coordination Activities
Occupational Safety and Health Administration
U.S. Department of Labor
Room N-3655
200 Constitution Avenue, N.W.
Washington, D.C. 20210
By facsimile:
202-693-1644
Electronic (email):
[email protected]

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OSHA Form 5-30.2
June 2011