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1. Sender Details: Full name, address, and employee ID (if applicable) of the person refusing work
2. Recipient Details: Full name and address of the employer or relevant supervisor
3. Date and Reference: Current date and any relevant reference numbers (employee ID, department, etc.)
4. Subject Line: Clear indication that this is a formal refusal to work
5. Formal Declaration: Clear statement of work refusal and identification of the specific work being refused
6. Legal Grounds: Citation of specific legal basis for the refusal (e.g., safety concerns, violation of labor laws)
7. Factual Background: Detailed description of the circumstances leading to the refusal
8. Closing Statement: Professional conclusion including any immediate actions being taken and expectation of response
9. Signature Block: Formal signature, printed name, and date
1. Previous Communications: Reference to any prior discussions or communications about the issue, include if there have been previous attempts to resolve the situation
2. Union Representative Details: Include if a union is involved or has been notified of the situation
3. Health and Safety Documentation: Include if the refusal is based on safety concerns, attach relevant safety reports or documentation
4. Alternative Solutions: Proposed alternative solutions or accommodations, include if you wish to maintain a constructive dialogue
5. Medical Documentation Reference: Include if the refusal is based on medical grounds, reference any medical certificates or reports
1. Supporting Documentation: Any relevant documents supporting the grounds for refusal (safety reports, medical certificates, photographs, etc.)
2. Communication Log: Record of previous relevant communications with employer about the issue
3. Witness Statements: If applicable, statements from colleagues or other witnesses supporting the grounds for refusal
4. Legal References: Copies of relevant sections of labor law or workplace safety regulations being cited
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