Received an OSHA Citation: The Appeal Process for Medical Practices

You opened an envelope from OSHA and found a citation with proposed penalties. Your first instinct might be to pay it and move on, or to call OSHA and argue. Neither is the right first move. OSHA citations carry legal consequences beyond the monetary penalty — they establish a violation history that can increase penalties for future inspections, they may require specific abatement actions within strict deadlines, and they become public record. Understanding the appeal process and your options is critical before you respond. Here is the complete roadmap for medical practices that have received an OSHA citation.

Understanding Your Citation

Every OSHA citation includes several components you need to understand before deciding how to respond:

• The violation classification. OSHA classifies violations as Other-than-Serious, Serious, Willful, or Repeat. The classification determines the penalty range and has significant implications for your practice’s future OSHA exposure. A Serious violation means OSHA determined there is a substantial probability of death or serious physical harm. A Willful violation means OSHA believes you intentionally or knowingly violated a standard. Willful and Repeat violations carry the highest penalties.
• The cited standard. The specific OSHA standard you allegedly violated — for medical practices, common citations reference 29 CFR 1910.1030 (Bloodborne Pathogens), 29 CFR 1910.1200 (Hazard Communication), 29 CFR 1910.134 (Respiratory Protection), and 29 CFR 1904 (Recordkeeping).
• The proposed penalty. As of 2026, maximum penalties are $16,550 per Serious violation and $165,514 per Willful or Repeat violation. Actual penalties depend on the severity of the violation, your employer size, good faith efforts, and violation history.
• The abatement deadline. OSHA specifies a date by which you must correct the cited hazard. This deadline applies even if you contest the citation, unless you specifically request a stay of abatement as part of your contest.

The 15-Working-Day Deadline

This is the most critical deadline in the entire process. From the date you receive the citation, you have exactly 15 working days to file a Notice of Contest if you intend to challenge any part of the citation — the violation itself, the classification, the penalty amount, or the abatement deadline. If you miss this window, the citation becomes a final order of the Occupational Safety and Health Review Commission (OSHRC) and cannot be appealed. There are extremely limited grounds for reopening a case after this deadline, and courts grant relief only in exceptional circumstances. Mark the deadline the day you receive the citation and do not let it pass without a decision.

Option 1: The Informal Conference

Before the 15-day contest deadline expires, you can request an informal conference with the OSHA Area Director who issued the citation. This is often the most practical and cost-effective path for medical practices, and it does not waive your right to file a formal contest. During the informal conference you can present evidence that the violation did not occur, that the hazard was less severe than cited, or that you had a good-faith compliance program in place. You can negotiate penalty reductions — OSHA Area Directors have authority to reduce penalties based on factors like prompt abatement, compliance history, and good faith. You can discuss the abatement deadline if the required corrections need more time. You can negotiate the violation classification — in some cases, a Serious violation can be reclassified to Other-than-Serious, which reduces the penalty and the impact on your violation history.

Request the informal conference early in the 15-day window. If you are not satisfied with the outcome, you still have time to file a formal Notice of Contest. Many citations are resolved at this stage with reduced penalties and agreed-upon abatement plans.

Option 2: Filing a Notice of Contest

If the informal conference does not resolve the matter (or if you prefer to contest directly), you must file a written Notice of Contest with the OSHA Area Office that issued the citation before the 15-working-day deadline. The notice must clearly state what you are contesting: the citation itself, the proposed penalty, the abatement date, or any combination. Your Notice of Contest does not need to be elaborate — a letter stating that you contest the citation and identifying the specific items contested is sufficient. However, it must be in writing and received by OSHA before the deadline.

Once OSHA receives your contest, the case is forwarded to the Occupational Safety and Health Review Commission (OSHRC), an independent federal agency that adjudicates contested OSHA citations. OSHRC will assign your case to an Administrative Law Judge (ALJ).

Option 3: Filing a Petition for Modification of Abatement

If you agree with the citation and penalty but cannot meet the abatement deadline, you can file a Petition for Modification of Abatement (PMA) before the original deadline. The PMA must explain why additional time is needed, describe the steps you have taken toward abatement, describe interim measures to protect employees, and propose a new abatement date. OSHA will grant reasonable PMAs when the employer demonstrates good faith and has protected employees during the extended abatement period.

The OSHRC Process: What to Expect

If your case proceeds to OSHRC, the process resembles civil litigation in many respects:

1. Assignment to an ALJ. An Administrative Law Judge is assigned to your case. The ALJ has authority to affirm, modify, or vacate the citation and to increase or decrease the penalty.
2. Settlement negotiations. The majority of OSHRC cases settle before hearing. The OSHA Solicitor’s Office (which represents OSHA before OSHRC) will engage in settlement discussions. Settlement can result in reduced penalties, reclassified violations, or modified abatement terms. This is where having experienced legal counsel provides the most leverage.
3. Hearing. If settlement fails, the ALJ conducts an evidentiary hearing where both sides present testimony and evidence. OSHA bears the burden of proving the violation by a preponderance of the evidence. You can challenge whether the standard applies, whether the conditions cited actually violated the standard, whether you had knowledge of the hazard, and whether the penalty amount is appropriate.
4. ALJ decision. The ALJ issues a written decision. Either party can petition for review by the full OSHRC Commission within 20 days.
5. Commission review. The three-member OSHRC Commission may grant discretionary review. If review is not granted, the ALJ’s decision becomes the final order.
6. Federal court appeal. A final OSHRC order can be appealed to the U.S. Court of Appeals within 60 days.

Strategies for Reducing Penalties

Whether through informal conference or formal contest, several factors can reduce your OSHA penalty:

• Good faith. Demonstrating that your practice had a written OSHA compliance program, conducted training, and made genuine efforts to comply — even if those efforts were imperfect — can reduce penalties significantly. This is where your compliance documentation proves its value.
• Size. OSHA provides penalty reductions for small employers. Practices with 25 or fewer employees typically receive a 40 percent size-based reduction; 26–100 employees receive a 20 percent reduction.
• History. If your practice has no prior OSHA citations in the last 5 years, you may qualify for a history-based reduction of up to 10 percent.
• Prompt abatement. Correcting the cited hazard immediately (ideally during or right after the inspection) demonstrates good faith and gives you leverage in penalty negotiations.
• Quick-fix abatement. For many medical office citations — missing OSHA 300 Log entries, incomplete Exposure Control Plan, expired training records — the fix can be implemented within days. Document every corrective action with dates and evidence.

Do You Need an Attorney?

For an Other-than-Serious citation with a modest penalty, an informal conference without legal counsel may be entirely appropriate. For Serious, Willful, or Repeat violations, for penalties exceeding $10,000, or for citations that could establish precedent affecting your future operations, retain an attorney experienced in OSHA law. The cost of non-compliance penalties can escalate dramatically if mishandled, and an experienced attorney can often negotiate outcomes that more than cover their fees in penalty reductions.

After the Citation Is Resolved

Whether you pay the penalty, settle, or win a contest, the citation is a signal that your OSHA compliance program needs attention. Conduct a thorough gap analysis of your compliance posture. Implement the corrective actions. Document everything. A follow-up inspection is possible, and demonstrating that you took the citation seriously and made systemic improvements is the best protection against escalated enforcement next time.