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

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

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

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

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

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

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

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

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

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

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