ISNetworld Safety Program Compliance Questionnaire

*ISNetworld® Safety Program Questionnaire United States

* Required Fields

* Company Name:		As you want it to Print in your Safety Program
* Contact Person:
* Business Phone:
* Cell Phone:
* Email:
* Username and Password for ISNetworld® Account Log in.
*Username:		Case Sensitive - must be exact
* Password:		Case Sensitive - must be exact
Re-enter password		Case Sensitive - must be exact
Check List - Submission to ISNetworld® - Please fill out the questions below in order for us to complete your ISNetworld® Safety Program requirements for the RAVS process.
How many employees does your company have?
Number of Company Vehicles?
Number of Forklifts?
Number of Supervisors?
What is your industry?
Please give us a brief description of what your company 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?
Do you have a 1st Aid Kit?
Where will the "Material Safety Data Sheets" be kept?
How many employees are on the safety committee?
If Tailgate Safety Mettings or Toolbox Talks are preformed, how often are they done?
Where will the emergency phone numbers be kept?
What is the time frame between :
Safety Meetings
Routine Safety Checks
Who is your RSO - Responsible Safety Officer for your company? (This is the person in charge of your company's safety program.
RSO Name:
Who is the name of the person who will be the “Safety Director” if different from the RSO person.
Safety Director:
What is the title of the supervisor or person who will be conducting the safety meetings? (Safety Director / Foreman / Jobsite Forman / Owner / Field Supervisor) Enter the name on the next line.
Safety Officer:
The date that you want to state that your safety programs were created
Date Created:
In the sections below in the chapters that ask for a specific name - please supply or list the RSO or the individual's name who 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	Name of Qualified First Aid / CPR Person on-site.
Name of "competent person" who will be responsible for all the “Behavior Based Safety” Implementation.
Behavior Based Safety Program:
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. * A copy of a Permit may be required.
Confined Space Names:		Please list all names
Crane Operator - Offshore	Name of Qualified Person
Crane Operator - Onshore	Name of Qualified Person
Discipline	Name of company Representative
Fall Protection	Name of "competent person" responsible for all fall safety issues
Fire Protections / Extinguishers	Name of Qualified Person
First Aid / CPR	Name of Qualified Person
Grounding Conductor Program	Name of Qualified Person
HAZCOM	MSDS (Material Safety Data Sheet) Master List Complete Hazardous Chemicals List may be requested
Ladder Safety	Name of Qualified Person
Lockout / Tagout	Name of "competent person" who will be responsible for all lockout / tagout exposure controls and safety issues. Please include list of safety equipment and controls.
Name of "competent person" who will be responsible for “NORM” or “Naturally Occurring Radioactive Materials” Implementation.
NORM:
PPE Assessments / PPE	List of employees / Equipment / Exposure
Scaffolds	Name of "competent person" who will be responsible for all fall protection safety.
Trenching / Shoring / Excavations	Name of Qualified Person
Welding, Cutting, Hot Work	Name of Qualifed 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.

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