What
is the full name of your organization
or company as you want it to print?

 

How many
employees does your company have?
 
Number of
Company Vehicles?
 
Number of
Forklifts?
 
Number of
Supervisors?
 
Number of
CPR certified employees?
 
Number of
First Aide certified employees?
 
What is
your industry?
 
Please give
a brief description of what your company
or business does.

 

Does your
company require a pre-employment physical
or drug screen?
  
Where is
your eyewash located?

 

If you will
be giving safety awards how many hours
are necessary to qualify?
 
Do you have
a current copy of the required State
and Federal Labor Law Posters?
 
Where will
the required State an Federal Labor
Law Posters be displayed?
 
Where will
all the safety notices be posted?
(Example: in the office)
 
Where will
the “Material Safety Data Sheets” be
kept? (Example: on the bulletin board)
 
How many
employees are on the safety committee?
 
How much
time between safety checks?
 
Where will
the emergency phone numbers be kept?
(Example: In the office)
 
What is
the name of the RSO? (Responsible
Safety Officer) Who is the person responsible
to implement the safety program?
 
What is
the title of the person who will be
conducting the safety meetings?
 
Please enter the name and email address of the
person who is filling out this information.
Name:
E-mail:
What address do you want your safety manual delivered
to?
Address:

 
City:
State:

              
Zip Code:
At which
phone number you can be reached?
 

      
Ext:
Alternate phone number or pager that you can be
reached?
 

      
Ext:
Are there
any special considerations or concerns
you have that need to be addressed in
your safety manual?
 
Please tell us how did you find out about
SafetyManual.com’s web site?

Other:

Will
you be paying by?:

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