Company Name:
Representative's Name:
Email:
Phone Number:
1. What type of work is your company involved in?
2. How many workers does your organization employ?
3. Which region(s) does your company service? (Please select all that apply)
4. Do your employees work in groups/crews? YesNo
If yes, how many different groups/crews are there?
5. What is the maximum number of active work sites at any given time?
6. What H&S system do you currently have in place? (e.g. H&S manual, standardized inspection sheets, risk assessments for all jobs, equipment inventory/preventative maintenance, etc.)
7. Does your organization currently employ a full-time Health & Safety Manager? YesNo
8. What training do your workers currently have? (i.e. WHMIS, Working at Heights, Supervisor, etc.)
9. What are your critical job tasks? (jobs with high risk of injury/death - i.e. working at heights, confined space, excavating, etc.)
10. How do you currently organize your documentation? (i.e. paper format, digital format, other)
11. Have you thought about going paperless? YesNo
12. Is your company interested in achieving specific safety designation? (i.e. COR, ISO 9001) YesNo
13. Have you ever applied for a specific safety designation before? YesNo
14. What are your health and safety goals and/or expectations?
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