Safety Stand Down - participation certificate survey

Thank you for participating in the National Stand Down for Fall Safety training event. Please complete this survey to receive a certificate from Cal/OSHA and DIR recognizing your company's efforts to prevent fall hazards in construction. All questions on the survey are required in order to obtain a certificate. The information you provide will not be sold or shared with any 3rd parties. Cal/OSHA is collecting this data to track statewide participation and to collect feedback in order to improve future safety campaigns. If you have any questions please email Communications@dir.ca.gov. Cal/OSHA will email your certificate within two business days of your completing this questionnaire.

1. What is the name of your company? *This question is required.

2. Which date did you attend a Stand Down event? *This question is required.

3. In what city is your company located? *This question is required.

4. Where is your company headquartered? *This question is required.

5. How many employees from your company participated? *This question is required.

6. What was the nature of your participation? *This question is required.

7. What was the duration of your training exercise?

8. Please provide contact information *This question is required.

First Name

Last Name

Title

Company Name

Street Address

Apt/Suite/Office

City

State

Zip

Email Address

Phone Number

URL

Safety Stand Down - participation certificate survey

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