OSHA Workplace Compliance Survey

Please fill out and submit the survey below and a B&W Compliance safety consultant will contact you as soon as possible to provide an assessment of your workplace Safety and Health compliance.

Contact Name

First NameLast Name

Contact Email*

Company Name

Company Website

Company Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

How many employees does your company have?*

Please answer the following questions about your company:

	Yes	No
Has your company established a comprehensive Safety and Health program or Injury and Illness Prevention Program (IIPP)?
Has an inspection been conducted to determine potential hazards at your facilities?
Has a complete inventory of all hazardous chemicals on company property been done, with Safety Data Sheets made accessible to employees?
Do your employees know what to do in case of an emergency such as fire, earthquake, hurricane, active shooter event, etc.?
Are your employees being exposed to respirable chemicals or dust?
Is there a potential for employee exposure to bloodborne pathogens or other potentially infectious material (OPIM)?
Do your employees operate forklifts or other industrial trucks?
Do your employees use powered hand tools?
Do your employees use, clean, service, or repair industrial equipment?

Are there any other hazards at your job sites or facility(ies) that haven't been covered above?

All information submitted and retained on this form will remain confidential within our company. We will not sell your information to third parties. Our intention is only to help you assess your company's compliance needs and let you know what help we can provide.

www.bandwcompliance.com