Business Name:
Address:

City:		State:
Phone:		Fax:
Zip:

Contact Person:
Title:
Email Address:
President/Upper Management:
Title:

Type of Business:
Main Activities/ Product/Services:

#Employees:		#Supervisors:
#Vehicles:		#Fork Lifts:
#People First Aid Trained:
#People CPR Trained:

THE FOLLOWING QUESTIONS MUST BE ANSWERED TO DEVELOP A COMPLETE PROGRAM!

Are Respirators Used: yesno	If So, What Kind & Why:
Is Hearing Protection Used: yesno	If So, Why/Why Not If Noisy:
Confined Space Exposure (Describe):
Construction Exposures:

Scaffolding Used: yesno	Over 30’: yesno	Permit: yesno
Excavation/ Underground Work :yesno	Over 5’ Deep: yesno	Permits: yesno
Building Demolition: yesno	Over 30’: yesno	Permits: yesno

INDUSTRY AND ACTIVITY-SPECIFIC NEEDS ANALYSIS

PLEASE CHECK ALL ACTIVITIES RELATIVE TO YOUR OPERATION

MANUFACTURING EXPOSURES		RETAIL TRADES INDUSTRY
Machine Guarding		Display Cases/Equipment
Power Tools		Racks and Counters
Pneumatic Tools		Retail Area
Grinders		Storage
Metal Working Machines		Maintenance
Die Casting Machines		Exits and Entrances
Press Brake		Customer and Public Exposure
Punch Press		Accident to the Public
Welding & Cutting		Parking Lot
Compressed Gases
Propane		CONSTRUCTION INDUSTRY
Hazardous Chemicals		Construction Tools
Spray Painting		Heavy Equipment
Specialty Machines		Excavation and Trenching
		Excavation and Trenching
		Concrete/Form Work
		Grading
MEDICAL INDUSTRY		Foundations
Medical Exposures		Floor/Hole Openings
HIV,HBV Exposures		Lifting Ropes, Slings, Chains
Blood Handling		Elevated Surfaces
Medical Equipment		Stud Guns
Barium X-Ray		Electrical
X-Ray Equipment		Plumbing
Nursing		Heating/Air Conditioning
Patient Handling		Finish Carpentry
Assaultive Behavior Exposure		Skill Saws, Radial Arm Saws
Prescription Drugs		Scaffolding
Housekeeping		Paints/Solvents
Infectious Disease		Chemicals
Infectious Waste		Compressor
		Compressed Gases
		Propane
RESTAURANT INDUSTRY
Kitchen Safety		Ice Machines
Knife Safety		Steamers/Pressure Cooking
Cooking Equipment		Dough Mixers
Fryers		Display Cases/Equipment
Food Machinery		Walk-In Freezer/Refrigerator
Microwave		Slicers
Ovens		Glassware
Blenders		Dish Washing Machine
Fire Protection Equipment
ACTIVITY-SPECIFIC NEEDS PLEASE CHECK ALL ACTIVITIES RELATIVE TO YOUR OPERATION
*Electrical Lockout/Tagout		*Construction "Safety Meetings"
*Confined Space Entry- Permit and Non-Permit		Construction Supervisor Safety Manual
*Motor Vehicle Operation		Food Services Safety
*Excavation & Trenching		Drug Free Workplace
*Industrial Trucks/Forklift		*Ergonomics
*Hearing Conservation		*Hazcom - MSDS Terms, Glossary & Procedures
*Bloodborne Pathogens & Medical Safety/Health		*Violence In The Workplace
*Respiratory Protection		*Gas Cylinders & Compressed Gases
*Welding Safety		Safety Incentive Program
*Personal Protective Equipment		*Fall Protection
S M O

NOTE: OSHA REGULATIONS STATE THAT THOSE PROGRAMS MARKED WITH AN ASTERISK (*)
REQUIRE A FORMAL PROGRAM WHICH IS TO BE "IN WRITING" IF THE EXPOSURE IS PRESENT!!

This comprehensive site-specific and activity-specific safety manual will be prepared in your company's name to your specifications as per the following Development Form to be shipped to you within 15 working days.  For a small additional fee we can Expedite the delivery, should you require a rush job.

Complimentary Company Analysis

Our experts will review your operational survey, perform a requirements analysis, and send you an informative report complete with suggested chapters to include in your personalized, site-specific safety plan

A Typical Safety Manual System Includes:

• Approximately 35 Chapters Covering Approx. 400 Pages,
• And your company name will appear approx. 200 times.
• The system also includes:
• An implementation guide
• A supervisors safety manual
• An employee safety handbook in English and Spanish if required.
• All OSHA required forms for mandated record keeping and documentation
• Will be provided to you, along with safety meeting scripts in English and in Spanish.
• The entire system will come to you on a CD in Microsoft Word Format for easy printing and editing.