Partners in Compliance; Through Quality, Value and Integrity Survey

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* 1. Contact Information

Name *

Company *

City/Town

State/Province

Email Address *

Phone Number *

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* 2. Are you the decision maker for your company?

Yes

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* 3. What is your priority with regards to training your staff? 1 being the highest priority and 4 being the lowest. Please choose one number for each box.

Cost

Time

Certification

Compliance

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* 4. Which of the following do you currently use for Safety Training?

	Yes	No
Online / Computer Based Training	Online / Computer Based Training Yes	Online / Computer Based Training No
Classroom Training	Classroom Training Yes	Classroom Training No
Self-Study Manuals	Self-Study Manuals Yes	Self-Study Manuals No
Webinars	Webinars Yes	Webinars No

Other (please specify)

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* 5. What would you rate higher in importance:

A safety system that effectively applies to workers

Training classes to receive a certificate

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* 6. Would Webinar based training with Global Hazmat be of interest to you and your company?

Yes

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* 7. Does your company handle any of the following:

	Yes	No
Explosives	Explosives Yes	Explosives No
Infectious	Infectious Yes	Infectious No
Radioactive	Radioactive Yes	Radioactive No
Lithium Batteries	Lithium Batteries Yes	Lithium Batteries No
Hazardous Waste	Hazardous Waste Yes	Hazardous Waste No

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* 8. Is your company involved with the movement of dangerous goods via any of these following modes:

	Yes	No
Air	Air Yes	Air No
Marine	Marine Yes	Marine No
Rail	Rail Yes	Rail No
US Bound	US Bound Yes	US Bound No

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* 9. Are you aware of the transition from WHMIS to GHS in 2015?

Yes

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* 10. If yes to above question, how is the current GHS training program being conducted in your workplace?

Online

Self-Study

In-House

Outside Trainer / Contractor

Instructor Level

Online

Self-Study

In-House

Outside Trainer / Contractor

Instructor Level

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* 11. Do you have a GHS system in place for:

	Yes	No
GHS Classifications	GHS Classifications Yes	GHS Classifications No
SDS Management	SDS Management Yes	SDS Management No
Labelling of products	Labelling of products Yes	Labelling of products No
Training and educating workers	Training and educating workers Yes	Training and educating workers No

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* 12. Which of the following do you currently use in your company?

	Yes	No
Safety Signs and/or Labels	Safety Signs and/or Labels Yes	Safety Signs and/or Labels No
Personal Protective Equipment (PPE)	Personal Protective Equipment (PPE) Yes	Personal Protective Equipment (PPE) No
Spill Kits	Spill Kits Yes	Spill Kits No
Absorbents	Absorbents Yes	Absorbents No

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* 13. What supporting safety items do you have in the workplace?

	Yes	No
Posters	Posters Yes	Posters No
Handbooks / Reference books	Handbooks / Reference books Yes	Handbooks / Reference books No
Regulations	Regulations Yes	Regulations No
Video	Video Yes	Video No

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* 14. When offering, handling, transporting, receiving dangerous goods do you use:

	TDG Labels	Placards	Shipping Documents	Dangerous Goods Packaging	N/A
Yes	Yes TDG Labels	Yes Placards	Yes Shipping Documents	Yes Dangerous Goods Packaging	Yes N/A
No	No TDG Labels	No Placards	No Shipping Documents	No Dangerous Goods Packaging	No N/A

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* 15. Are there any safety, compliance or hazmat products you would like to see us offer?

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* 16. Does your company have the following written plans or procedures:

	Yes	No
Spill/Hazardous Release	Spill/Hazardous Release Yes	Spill/Hazardous Release No
Hazardous Waste	Hazardous Waste Yes	Hazardous Waste No
Safety Manual	Safety Manual Yes	Safety Manual No
None	None Yes	None No

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* 17. Has your company conducted internal audits for any of the following:

	Yes	No	N/A
Hazardous Materials	Hazardous Materials Yes	Hazardous Materials No	Hazardous Materials N/A
Hazardous Waste	Hazardous Waste Yes	Hazardous Waste No	Hazardous Waste N/A
Spill Response	Spill Response Yes	Spill Response No	Spill Response N/A
Chemical Inventory	Chemical Inventory Yes	Chemical Inventory No	Chemical Inventory N/A
Other Safety Topics	Other Safety Topics Yes	Other Safety Topics No	Other Safety Topics N/A

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* 18. Do you dispose any of the following hazardous wastes? (select all that apply)

Biomedical waste (sharps / first aid)

Flammables (paint, solvent, fuels etc)

Gases (aerosols, cylinders etc)

Corrosives (batteries, chemicals etc)

Lithium Batteries

Absorbents (oil or fuel contaminated)

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* 19. Does your company use a third party hazardous waste contractor?

Yes

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* 20. If Global HazMat could show you a system to comply and possibly reduce your overall Hazardous Waste cost, would you be interested?

Yes

Maybe

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* 21. Global HazMat offers an Absorbent Service Program. We drop off product and handle the waste in a cost effective method. Would this be of interest to your company?

Yes

Maybe

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* 22. What topics would you like to be kept informed of by Global Hazmat?

	Yes	No	Maybe
Transportation of Dangerous Goods (TDG) - any mode	Transportation of Dangerous Goods (TDG) - any mode Yes	Transportation of Dangerous Goods (TDG) - any mode No	Transportation of Dangerous Goods (TDG) - any mode Maybe
Hazardous Waste Management	Hazardous Waste Management Yes	Hazardous Waste Management No	Hazardous Waste Management Maybe
Regulatory Changes	Regulatory Changes Yes	Regulatory Changes No	Regulatory Changes Maybe
WHMIS to GHS Implementation	WHMIS to GHS Implementation Yes	WHMIS to GHS Implementation No	WHMIS to GHS Implementation Maybe
Spill Management	Spill Management Yes	Spill Management No	Spill Management Maybe
Industry News	Industry News Yes	Industry News No	Industry News Maybe
Global Hazmat Specials, Offers and Promotions	Global Hazmat Specials, Offers and Promotions Yes	Global Hazmat Specials, Offers and Promotions No	Global Hazmat Specials, Offers and Promotions Maybe

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* 23. How would you like to receive information from us?

Website (blog/articles)

Client Services Representative

All

Website (blog/articles)

Client Services Representative

All

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* 24. Is there anything else you and your company would like to see Global Hazmat provide?

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* 25. How likely is it that you would recommend Global Hazmat to a friend or colleague?

Not at all likely

Extremely likely

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* 26. BONUS For 3 qualified referrals Global Hazmat will offer you 1 FREE year email technical support (Value $900)
Please provide name, company, telephone, number, email

Name
Company
Telephone
Email

Question Title

* 1. Contact Information

Question Title

* 2. Are you the decision maker for your company?

Question Title

* 3. What is your priority with regards to training your staff? 1 being the highest priority and 4 being the lowest. Please choose one number for each box.

Question Title

* 4. Which of the following do you currently use for Safety Training?

Question Title

* 5. What would you rate higher in importance:

Question Title

* 6. Would Webinar based training with Global Hazmat be of interest to you and your company?

Question Title

* 7. Does your company handle any of the following:

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* 8. Is your company involved with the movement of dangerous goods via any of these following modes:

Question Title

* 9. Are you aware of the transition from WHMIS to GHS in 2015?

Question Title

* 10. If yes to above question, how is the current GHS training program being conducted in your workplace?

Question Title

* 11. Do you have a GHS system in place for:

Question Title

* 12. Which of the following do you currently use in your company?

Question Title

* 13. What supporting safety items do you have in the workplace?

Question Title

* 14. When offering, handling, transporting, receiving dangerous goods do you use:

Question Title

* 15. Are there any safety, compliance or hazmat products you would like to see us offer?

Question Title

* 16. Does your company have the following written plans or procedures:

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* 17. Has your company conducted internal audits for any of the following:

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* 18. Do you dispose any of the following hazardous wastes? (select all that apply)

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* 19. Does your company use a third party hazardous waste contractor?

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* 20. If Global HazMat could show you a system to comply and possibly reduce your overall Hazardous Waste cost, would you be interested?

Question Title

* 21. Global HazMat offers an Absorbent Service Program. We drop off product and handle the waste in a cost effective method. Would this be of interest to your company?

Question Title

* 22. What topics would you like to be kept informed of by Global Hazmat?

Question Title

* 23. How would you like to receive information from us?

Question Title

* 24. Is there anything else you and your company would like to see Global Hazmat provide?

Question Title

* 25. How likely is it that you would recommend Global Hazmat to a friend or colleague?

Question Title

* 26. ***BONUS*** For 3 qualified referrals Global Hazmat will offer you 1 FREE year email technical support (Value $900)Please provide name, company, telephone, number, email

* 26. BONUS For 3 qualified referrals Global Hazmat will offer you 1 FREE year email technical support (Value $900)
Please provide name, company, telephone, number, email