1.How many Full Time Employees (FTEs) do your company employ?

2.What is your company’s primary line of business? (check all that apply)

Construction

Maintenance

Operations

Combination

3.Does your company have a written heat illness prevention program?

Yes

No

4.Does your company have a process for monitoring the temperature of the work environment for excessive heat?

Yes

No

5.Does your company have a method for monitoring employee health while working in high heat environments?

Yes

No

6.Does your company train its employees on prevention of heat related illness?

Yes

No

7.Does your company currently have an acclimatization process for employees exposed to high heat?

Yes

No

8.Is the identification of heat related hazards included in your company’s Job Hazard Analysis process?

Yes

No

9.What safety controls does your company apply to manage heat stress in the workplace?

*10.How many heat related injuries/fatalities has your company experienced in the past 5 years?(Required.)

None

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