Safety Program Customization Form

COMPANY SPECIFIC DETAILS

Company Legal Name *

Common Company Name *

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Phone

Name of Most Senior Management/Owner of Company *

First

Last

NOTE: (Most Senior Management/Owner who will be signing the policies)

Upload Company Logo

Click or drag files to this area to upload. You can upload up to 2 files.

Company Contact Person (for this order) *

First

Last

Email *

Phone Number

Industry

Details of Products/Services offered

What areas do you serve? *

Number of Employees *

(If applicable)

Number of Drivers (if registered under National Safety Code for vehicles over 4500kgs)

(If applicable)

Number of Subcontractors - enter 0 if you do not use subcontractors *

(If applicable)

Please Upload a company schematic showing levels in company and employee positions in each level.

Click or drag a file to this area to upload.

SAFETY PROGRAM SPECIFIC

What service(s) do you need a safety program for? *

If Other please enter information (website)

Log In details for Services Above

If COR/SECOR Name Certifying Partner

Original Safety Program was been created on: *

Your Original Safety Program was been created on:

How many revisions have been completed so far - revision #

Privacy Officer Name *

First

Last

NOTE: This is the person who is responsible to make sure that all of the employees records are kept confidential & locked up.

Which worksites do your company employees work in

Explain other:

NOTE: Is it a home office or public? What is completed in the shop? Do you have a mechanic or use outside service provider?

List Type of Equipment / Machines Used

eg. cats, hoes, buggies, welders, etc.

COR Safety Program Sections

The sections above are required and included in every safety manual except where indicated (There are exceptions eg. owner operator does not need discipline policy)

Safe Work & Best Practices & Procedures. Check all that may apply to your company requirements. (If you have entered ISN, COMPLYWORKS login details you can skip this section)

The sections above may be required and are specific to your company activities and area of operation. These pass requirements for ISNetworld (RAVS) as well as other 3rd party prequalification services.

EMERGENCY RESPONSE - Potential emergencies your employees may face *

Explain Other

Emergency Contact #1 *

First

Last

Position

Emergency Contact #2

First

Last

Position

Upload your company logo

Click or drag a file to this area to upload.

Acknowledgement *

I understand and agree to the following terms:

The purchaser may modified & reproduce copies of the materials for the sole purpose of personalizing their own company safety program and distributing to their company employees ONLY. No products or materials purchased from Safety2Go or Safety Programs.ca may be resold, copied, reproduced, modified, republished, uploaded, posted, transmitted, or distributed in any form or by any means for the purpose of resale or for use by another company. All rights not expressly granted herein are reserved. Any unauthorized use or resale of the materials appearing on this site will violate copyright, trademark and other applicable laws and could result in criminal or civil penalties.