Workplace Safety Toolkit

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* 1. Name

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* 2. Organization

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* 3. Email Address

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* 4. Indicate your commitment to the campaign. Check all that apply.

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* 5. Who will be responsible at your organization for the collection and submission of workplace violence data back to SCHA?
Please provide their name and contact information below. If unsure, we will reach back out to you at a later date.

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* 6. Would you like to be added to a communications list to receive updates related to the campaign or workplace safety?

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