Safe + Sound Week 2017 - Participation Certificate Questions – DRAFT – 3/23/2017
1) Name of Business or Organization*:
_____[FILL IN BLANK]___________________________________________
2) City/State and Zip code*:
_____[FILL IN BLANK and DROP DOWN]___________________________________________
3) Industry*
_____ [DROP DOWN – See below]__________________________________________
4) Number of Workers Impacted*:
______[FILL IN THE BLANK]______________________________________
5) Which safety and health program core elements did you include in your Safe + Sound Week activities? (Check all that apply) [CHECK BOX]
Management Leadership
Worker Participation
Finding and Fixing Hazards
6) Participating in Safe + Sound Week had a positive impact on safety & health in my organization.
Strongly Disagree 1 2 3 4 5 NA Strongly Agree
[CHECK BOX]
Comments: ______[FILL IN THE BLANK]_________________________
7) The resources provided on the Safe + Sound Week website were helpful in planning my events.
Strongly Disagree 1 2 3 4 5 NA Strongly Agree
[CHECK BOX]
Comments: ______[FILL IN THE BLANK]_________________________
8) Tell us about your Safe + Sound Week experience. What did you do?
____[FILL IN THE BLANK] ________________________________________
9) What would improve your participation experience in the future?
____[FILL IN THE BLANK] ________________________________________
10) Would you like to share a quote about any successes, impacts, or outcomes related to your Safe + Sound Week activities?
____[FILL IN THE BLANK] ________________________________________
11) Are you interested in sharing more about your experience?
Yes
No
If yes, please provide contact information:
Contact Name: _____________________________________________________
Contact Email: _____________________________________________________
Contact Phone Number: _____________________________________________
INDUSTRY DROP DOWN LIST
Accommodation and Food Services
Agriculture, Forestry, Fishing and Hunting
Arts, Entertainment, and Recreation
Construction
Education Services
Financial Activities
Health Care and Social Assistance
Information
Manufacturing
Mining
Oil and Gas
Professional and Business Services
Public Administration
Real Estate Rental and Leasing
Trade (Wholesale/Retail)
Transportation and Warehousing
Utilities
Other: ___________________________________
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| Author | Barclay, Pamela - OSHA |
| File Modified | 0000-00-00 |
| File Created | 2021-01-22 |