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* 1. Please give us a sense of your safety and health practice now. Check the box that most applies.

  I am not aware that this is something we should do. I am aware but have NOT implemented this.  I am aware and have implemented this.
We give a SAFETY ORIENTATION to all employees
We have a SAFETY COMMITTEE
We discuss SAFETY TOPICS at meetings
We have a SAFETY BULLETIN BOARD
We have a written ACCIDENT PREVENTION PROGRAM
We offer FIRST AID TRAINING
We require PERSONAL PROTECTIVE EQUIPMENT where appropriate 
Our people know when and how to REPORT INJNURIES
We conduct an ANNUAL REVIEW of our records, training, inspections and policies
We have a policy on workplace VIOLENCE and THREATS
L&I/WISHA POSTERS are posted in our workplace
LIGHTING is adequate for work
We conduct HOUSEKEEPING such that our space is clean and clear of obstructions
Our place is SANITARY with clean water, bathrooms, and regular garbage disposal
SMOKING is prohibited from workplace
All ELECTRICAL OUTLETS are GFCI protected
We have FIRE EXTINGUISHERS that are portable and accessible 
We have clear marked and known EXIT ROUTES

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* 2. What types of activities or concerns does your organization involve? (check all that apply)

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* 3. It is your responsibility to provide a safe and healthy workplace free from recognized hazards. This is defined by the following items listed below.
Please check any of these topics that you would like support with.

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* 4. Comments in regard to question 3

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* 5. What safety and health issues have come up for your organization? 

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* 6. What safety and health questions do you have?

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* 7. Please tell us a bit more about you so that we can focus the toolkit to who most needs it.
What is your field of service?

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* 8. What is your budget size? (Estimated annual) 

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* 9. Number of paid staff (Estimated)

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* 10. Number of volunteers (Estimated Annual)

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* 11. Do you have a safety expert on your team? If so, please share their contact information below. (Name & Email)

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* 12. If you would like to be added Washington Nonprofits' email list and receive notification when the Safety and Health Toolkit becomes available, please provide your contact information below

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