On-Site Safety & Health Consultation Application
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* Indicates Required Field
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(no dashes e.g. 555554444) |
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(no dashes e.g. 555554444) |
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(no dashes e.g. 5554443333) |
(no dashes e.g. 5554443333) |
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*Is the facility: |
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*Have you had an OSHA Compliance visit in the past 12 months? |
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Notice of Obligation: If an Occupational Safety and Health Administration (OSHA) inspection should occur at your facility, the OSHA Compliance Officer will not know about the consultation visit. You are not required to inform the Compliance Officer of our service, but you must provide a copy of our chemical sampling or noise monitoring results if it is requested (29 CFT 1910.1020(e)(3)). The OSHA Compliance Officer will not be legally bound by the advice given by our consultant, nor will the consultant be legally responsible for any OSHA citations. |
Before accepting this service from the state of Oklahoma, the company agrees to correct all hazards identified as "serious" within the established time frame. Also, when feasible, the company agrees to implement temporary protective measures for "serious" hazards until the hazards can be corrected permanently. Extensions may be granted if you encounter difficulties, but these extensions must be requested in writing on or before the correction due date. |
*PHOTOGRAPHY: I hereby authorize the Oklahoma Division of Industrial Health and Safety to take pictures of both hazardous situations and good examples of safety and health control measures for documentation purposes and also for use in training and promotional activities. |
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CERTIFICATION: To the best of my knowledge and belief, the statements on this form are true and correct. If submitted electronically, this form will be considered signed.
Typing name and title below signifies authorization of the consultation service.
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(Format: mm/dd/yyyy)
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If you do not wish to electronically submit, you may sign and fax or mail the completed form to:
Oklahoma Department of Labor
3017 N Stiles, Suite 100
Oklahoma City, OK 73105
(405) 521-6100
FAX: (405) 521-6020
If you do not receive an acknowledgement letter within two weeks of submitting your application, please call.
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