Customization Form - Osha Safety Manual

Customization Form

1 Organizaton

2 Contact Information

3 Company Info

4 Safety Info

5 Safety Committee

6 Mailing

7 PreQualification Details

8 PreQual Q1

9 PreQual Q2

Organization
Your Logo
PNG, EPS or Vector Graphic Preferred
Please Fill out the form below in order to complete your order.
What is your Safety Manual order number?
From the invoice we emailed you. (not required)
What is the full name of your Organization or Company as you want it to print?*

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Contact Information
Your Name*
First Last
Email*
Phone Number*
Primary Phone Type*
Alternate Phone Number*
Alternative Phone Type*
Fax Number

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Company Information
How many employees does your company have?
Number of Company Vehicles?
Number of Forklifts?
Number of Supervisors?
What is your industry?
Please give a brief description of what your company or business does.
Other Industry

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Safety Info
Please give a brief description of what your company or business does.
Does your company require a pre-employment physical or drug screen?
If you have an Eyewash, where is it located?
Where will all the Safety Notices be Posted?
Examples: in the break room, on the bulletin board, next to the time clock, in the job site trailer, in the office.
Do you have a 1st Aid Kit?
Where is the First Aid Kit located?
Where will the "Material Safety Data Sheets" be kept?

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Safety Committee
How many employees are on the safety committee?
How often does the safety committee meet?
How much time between routine safety checks?
Other
How much time between safety meetings with all of the employees?
Other
If Tailgate Safety Meetings or Toolbox Talks are performed, how often are they done?
Other
Where will the emergency phone numbers be kept?
What is the name of the RSO? (Responsible Safety Officer)
What is the title of the person who will be conducting the safety meetings?
Other

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Mailing
What is the physical address of your company? This address will appear on the cover of your Safety Manual.
Company Name
Address
Street Address Address Line 2 City State ZIP / Postal Code
Are there any special considerations or concerns you have that need to be addressed in your safety manual?
Other
Please tell us how did you find out about OshaSafetyManual.com's web site?

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PreQualification Details
PreQualifications Questionnaire
NOTE: If you are only placing an order for an OSHA Safety Manual / IIPP – you can skip this page
Please select Login Accounts You Have:
- ISNetworld® Account
- PICS
- PEC
- Other
- ISNetworld®
- ISNetworld® Username:
- ISNetworld® Password:
- Address as listed on your ISNetworld© Account:
  Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
- PICS
- PICS Username:
- PICS Password:
- Address as listed on your PICS Account:
  Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
- PEC
- PEC Username:
- PEC Password:
- Address as listed on your PEC Account:
  Street Address Address Line 2 City State ZIP / Postal Code Country
- Other Service
- Other Service Username:
- Other Service Password:
- Address as listed on your Other Account:
  Street Address Address Line 2 City State ZIP / Postal Code
Instructions
In the following sections in the chapters that ask for a specific name - please supply or list the RSO or the individual's name that is responsible for that chapter / section. In most cases we are able to use the term "Competent Person" if you do not have a specific name to insert. If you are not required to submit for a specific chapter / section, please fill out the information in case that chapter / section is added to your required safety program. This will help expedite any further updates. Chapters / Sections not listed do not require any further specific information.
Bloodborne-pathogens-First-aid: Name of Qualified First Aid / CPR Person on the job-site:
Confined-Space-Names: Confined Space / Permit Confined Space:
(insert your list of Employees including: Authorized entrants, attendants, entry supervisors, persons who test or monitor the atmosphere in a permit space:
confined-space-names

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PreQual Q1
NOTE: If you are only placing an order for an OSHA Safety Manual / IIPP – you can skip this page
Crane-operator-Off-shore: Name of Qualified Person:
Crane-operator-On-shore: Name of Qualified Person:
Fall-Prevention: Name of "competent person" responsible for all fall safety issues:
Fire-Protection: Name of Qualified Person
Person in charge First-aid-CPR program and training(They do not have to be the person conducting the training): Name of Qualified Person
Grounding-Conductor Program: Name of Qualified Person
HAZCOM Program: Name of Qualified Person

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PreQual Q2
NOTE: If you are only placing an order for an OSHA Safety Manual / IIPP – you can skip this page
Ladder-Safety: Name of Qualified Person
Lockout-tag-out: Name of "competent person" who will be responsible for all lockout / tagout exposure controls and safety issues.
Scaffolds: Name of "competent person" responsible for all scaffolds and fall protection safety issues with scaffolds.
Trenching-shoring-excavations: Name of Qualified Person
Welding-cutting-hot-work: Name of Qualified Person
What is your timeline? Are you in a big rush to get this uploaded and approved? We normally can upload your safety programs within 2-3 days at the latest.
Although if you need it right away we can get it done possibly today or within 24 hours.
What is your timeline?
Any other Comments or Concerns
Upload Photo(s) for Custom Cover
Drop files here or

Accepted file types: jpg, png, tif, tiff.
Up to 3 images can be uploaded.
Company Logo
- CAPTCHA
Comments
This field is for validation purposes and should be left unchanged.

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Organization

Please Fill out the form below in order to complete your order.

Contact Information

Company Information

Safety Info

Safety Committee

Mailing

What is the physical address of your company? This address will appear on the cover of your Safety Manual.

PreQualification Details

PreQual Q1

PreQual Q2

Assistance

Products

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