National Safety Stand-Down to Prevent Falls in Construction Event Registration

National SJ��ty...�ta3��J?.9�n - Prevent Falls in Construction I Certificate of Participation I Occupational Sa... Page 1 of 3
DEPARTMENT OF LABOR

OSHA

English I Spanish

Find it in OSHA
. ATO Z INDEX
ABOUT OSHA • WORKERS • EMPLOYERS • REGULATIONS • ENFORCEMENT • TOPICS • NEWS & PUBLICATIONS • DATA • TRAINING •

Join the
National Safety

Stand-Down
To Prevent Falls in Construction
May 7-11, 2018

Home

Resources

Events

Certificate of Participation

Share With Us

Highlights

Back to Construction Industry

Certificate of Participation
Thank you for joining thousands of employers in the 2018 Fall Prevention Stand-Down. This certificate of participation is yours in
recognition of the time and effort you devoted to talk about preventing falls with your crew. Of course, every day should be fall
prevention day, so I challenge you to build on the steps you took today. I hope you will keep talking to your employees and
dedicating yourself to preventing falls at your worksites.
Sincerely,
Dean McKenzie, Director
Directorate of Construction
NOTICE: The Fall Prevention Stand-Down certificate will download as a PDF. It is recommended that you complete this form on a desktop or laptop
computer with a screen resolution set at a MINIMUM of 1360 x 768 and the browser is maximized on the screen.

To download a certificate for your business's participation in the Stand-Down, please fill out the information below. Once you submit this information, you will
receive a certificate (a printable PDF document will display) with your business name, project title and level of participation (depending on the number of years
of participation). Please note that you are not required to request a certificate and that if you choose to do so OSHA will not use the information you provide for
any purpose other than evaluating the Stand-Down campaign and planning future outreach efforts. Also note that the certificate does not represent an
assessment of compliance with OSHA standards at your worksite(s).

Items marked

* are mandatory to print the certificate.

1. Name of Business*:
2. Project Title:

')

C'+-....

+-,... X,

, Limit to 40 characters
r ProjectTitle
( Colo,..+ "'""o

r:-:-J

http://draft.osha.gov/StopFallsStandDown/certificate.htrnl

4/26/2018

National
Safety Stand-Down
Falls in Construction I Certificate of Participation I Occupational Sa... Page 2 of 3
- - - - - Prevent
- · · · ,r-- -· -· ·----· , ·
L--l

5. Number of Employees

#####

(Numbers only field)

who participated*:

6. Number of years of

Select one...

participation:

�

Generate Certificate

Share Your Story With Us
If you want to share information with OSHA on your Safety Stand-Down, Fall Prevention Programs or suggestions on how we can improve future initiatives like
this, please send your email to [email protected]. Also share your Stand-Down story on social media, with the hashtag: #StandDown4Safety.

0MB Control Number xxxx-xxxx
Expiration date: xx/xx/xxxx
PAPERWORK REDUCTION ACT
Public reporting burden for this voluntary collection of information is estimated to average 10 minutes per response, including time for reviewing instructions, searching existing data sources,
gathering and maintaining the data needed, and completing and reviewing the collection of information. OSHA will use this information to evaluate the National Fall Prevention Safety Stand­
Down. Persons are not required to respond to the collection of information unless it displays a current valid 0MB control number. If you have any comments about this estimate or any other
aspects of this data collection, including suggestions for reducing this burden, please send them to [email protected] or to US Department of Labor, OSHA Directorate of Standards and
Guidance N-3609, 200 Constitution Avenue, NW, Washington, DC 20210.

UNITED STATES
DEPARTMENT OF LABOR
Occupational Safety and Health Administration
200 Constitution Ave., NW,
Washington, DC 20210
800-321-6742 (OSHA)
TTY
www.OSHA.gov
FEDERAL GOVERNMENT

OCCUPATIONAL SAFETY AND HEALTH

ABOUT THE SITE

White House

Frequently Asked Questions

Freedom of Information Act

Affordable Care Act

A - Z Index

Privacy & Security Statement

Disaster Recovery Assistance

Freedom of Information Act

Disclaimers

USA.gov

Read the OSHA Newsletter

Important Web Site Notices

Plain Writing Act

Subscribe to the OSHA Newsletter

Plug-ins Used by DOL

Recovery Act

OSHA Publications

RSS Feeds from DOL

No Fear Act

Office of Inspector General

Accessibility Statement

http://draft.osha.gov/StopFallsStandDown/certificate.html

4/26/2018