what is the name of
your company?
company street address
company city
company state
Alaska
Alabama
Arkansas
Arizona
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Iowa
Idaho
Illinois
Indiana
Kansas
Kentucky
Louisiana
Massachusetts
Maryland
Maine
Michigan
Minnesota
Missouri
Mississippi
Montana
North Carolina
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Nebraska
New Hampshire
New Jersey
New Mexico
Nevada
New York
Ohio
Oklahoma
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Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Virginia
Vermont
Washington
Washington DC
Wisconsin
West Virginia
Wyoming
Alberta
British Columbia
Manitoba
Ontario
Quebec
Please Select
company zip or postal code
please enter your name
what is your title?
what is your phone number?
what is your email
address?
what does your company do?
(a brief description about
what your company makes or does)
how many people work at
the company, where you will use the safety manual?
Please Select
1 - 40
41 - 99
100 - 250
251 - 400
401 - 1,000
> 1,000
what is the title of the
senior management person at that company location?
Please Select
President
Vice President
General Manager
Plant Manager
Other
please enter the name of
that senior management person
please enter the name of
your safety officer
how many members comprise
your safety committee?
Please Select
2
3
4
5
6
7
8
9
10
> 10
where are your emergency
phone numbers posted?
Please Select
Bulletin Board
Lunch Room
Office
Safety Board
Other
where are your osha and
workers compensation posters posted?
Please Select
Bulletin Board
Lunch Room
Office
Safety Board
Other
does your facility use
natural gas?
Please Select
Yes
No
what is the designation of
your front line supervisors?
Please Select
Supervisor
Cell Lead
Team Leader
Manager
Other
how many front line
supervisors are there?
Please Select
1
2 - 8
9 - 20
> 20
what is the designation of
your worker level employees?
Please Select
Employee
Operator
Team Member
Associate
Other
how many worker level
employees are there?
Please Select
1 - 40
41 - 99
100 - 250
251 - 400
401 - 1,000
> 1,000
do any of your employees
have to perform first aid as part of their job?
Please Select
Yes
No
what are the job titles of
those employees that have to perform first aid as part of their job?
where are your first aid
kits located?
do you conduct drug and
alcohol testing?
Please Select
Yes
No
do you have any
Maintenance employees?
Please Select
Yes
No
if so, how many
maintenance employees are there?
Please Select
1 - 5
6 - 10
11 - 20
21 - 30
31 - 40
> 40
where are your Material
Safety data sheets kept (msds's)?
(required chemical
information sheets.)
do you have any forklifts?
Please Select
Yes
No
do your employees wear
hearing protection?
Please Select
Yes
No
do your employees wear
safety glasses?
Please Select
Yes
No
do your employees use
portable ladders?
Please Select
Yes
No
do your employees perform
welding?
Please Select
Yes
No
do you have confined
spaces on your site?
(i.e., boilers,
process tanks, silos, baghouses, etc.)
Please Select
Yes
No
do your employees enter
confined spaces?
Please Select
Yes
No
do your employees wear
respirators?
Please Select
Yes
No
what other equipment do
they wear?
who should we contact?
What is their phone
number?
what other information
would you like to add?
which safety manual
solution are you interested in?
Please Select
Gold
Silver
how would you like to pay
for the safety manual solution?
Please Select
Check
MasterCard
Visa
how did you find SHE Solutions, LLC?
Please Select
Friend
Previous Client
Google
ASSE
Yahoo
Other Search Engine
Other
thank you
