Customization Form OSHA Safety Manual Customization Form Safety Manual order number if you have it (not required) Full name of your organization or company: Full Name of the person filling out this form: Email address of the person filling out this form: Primary Phone Number: Alternate Phone Number: Fax Number: Number of employees: Number of Company Vehicles: Number of Forklifts: Number of Supervisors: What is your industry? Please select your answerAgricultureAmusement ParkAttorneyAutomotive RepairAuto Dealership Sales & ServiceCarpet & Flooring Sales and InstallationCateringCemetaryChiropractic OfficeChurchChrome & Metal Plating ShopCity MunicipalityConstructionDaycareDental OfficeEngineering ContractorElectrical ContractorFood ServiceFumigationHair & Nail SalonHealth CareHospitalHousingJanitorialLaboratoryLandscapingLoggingManufacturingMetal Polishing ShopMold RemediationNursing/Retirement HousingOffice WorkPainting - AutomotivePainting - Residential/CommercialPetrochemicalPetroleum DrillingPetroleum ProductionPharmacyPhotographyPlumbingPlumbing - Heating - A/CPrintingProperty ManagementRetail SalesRestaurantRoofing ContractorSecuritySchoolShippingTire StoreTelecommunicationsTermite & Pest ControlTextile ManufacturingTextile Warehousing & DistributionUpholstery ShopTruckingTowing CompanyVeterinarianWarehousingWinery/VineyardX-Ray / Imaging CenterOther - specify in box belowPlease give a brief description of what your company or business does. Does your company require a pre-employment physical or drug screen? Please select your answerYesNoIf you have an eyewash, where is it located? Where will all the safety notices be posted? HintDo you have a 1st Aid Kit? Yes NoWhere is the First Aid Kit located? Where will the "Material Safety Data Sheets" be kept? HintHow many employees are on the safety committee? How often does the safety committee meet? Please select your answerDailyWeeklyEvery Two WeeksMonthlyQuarterlyOther - Specify in box belowHow much time between routine safety checks? Please select your answerDailyWeeklyEvery 2 WeeksMonthlyQuarterlyOther - Specify in box belowHow much time between safety meetings with all of the employees? Please select your answerDailyWeeklyEvery 2 WeeksMonthlyQuarterlyOther - Specify in box belowIf Tailgate Safety Meetings or Toolbox Talks are performed, how often are they done? Please select your answerNot PerformedDailyWeeklyMonthlyQuarterlyAs NeededAt the start of each new procedureOther - specify in box belowWhere will the emergency phone numbers be kept? HintWhat is the name of the Responsible Safety Officer (RSO)? HintWhat is the title of the person who will be conducting the safety meetings? Please select your answerSafety DirectorHuman Resource DirectorForemanJobsite ForemanOwnerPresidentOther - specify in box belowWhat is the physical address of your company? This address will appear on the cover of your Safety Manual. NO P.O. BOXES Are there any special considerations or concerns you have that need to be addressed in your safety manual? Please tell us how you found the SafetyManual.com's website? Please select your answerAOLAsk JeevesBingDogpileGoGoogleGotoiWonLooksmartLycosNBCiMSNYahooFriendOther - specify in box belowPlease enter the text that is in the image. Additional Comments:
