Contractor Ez Quote Form Page 3
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7Safety Information
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Is a safety program utilized in the workplace?
If yes, is the program?
Yes
No
Written
Verbal
Does the safety program address/include:
(Please Check All that Apply)
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Accident/Injury Investigation
Routine Safety Inspections
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Ladder Tie Offs
Safety Committee/Safety Officer
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Lock Out/ Tag Out Procedures
Safety Data Sheets (SDS)
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Machine Guards (including power tools)
Safety Incentive Program
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Onsite Supervisor
Safety Orientation
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OSHA Training
Substance Abuse Awareness Training
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Personal Fall Protection
Third Party Safety Company
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Progressive Disciplinary Action Plan
Other: ____________________
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Return to Work Program
Please check the personal protective equipment that is enforced:
( Please Check All That Apply)
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Dust Masks
Rubber Boots
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Eye Protection
Respirators (including fit tests)
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Gloves
Safety Vests
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Hard Hats
Steel Toe Boots
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Hearing Protection
Other: ____________
Please check all OSHA guidelines that apply:
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Confined Spaces
Sloping
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Chemical/Solvent Storage (GHCS)
Signs, Signals and Barricades
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Fall Protection
Trenching
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Overhead Protection
Ventilation
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Scaffolding
Other: __________
Does the driving program address/include:
(Please check all that apply)
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Cell Phone Usage
Progressive Disciplinary Plan
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Impaired/Aggressive/Distracted Driving
Mandatory Seat Belt Usage
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Initial and Routine MVR Checks
Vehicle Tracking Device
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Parent category: Financial