OSHA Safety Stand Down Commitment Form: Oil & Gas 2013

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* 1. CONTACT INFORMATION:

Name: *

Company: *

Address: *

Address 2:

City/Town: *

State: *

ZIP: *

Country:

Email Address: *

Phone Number:

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* 2. NUMBER OF JOBSITES INSPECTED:

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* 3. NUMBER OF HAZARDS IDENTIFIED AND CORRECTED:

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* 4. NUMBER OF WORKERS TRAINED:

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* 5. NUMBER OF SUBCONTRACTORS INCLUDED IN THIS REPORT:

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* 6. HOW DID YOU FIND OUT ABOUT THE STAND DOWN?

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* 7. IF YOU FOUND OUT THROUGH A STEPS NETWORK WHICH ONE?

MonDaks Safety Network

AESX

ArkLaTex STEPS

Four Corners E&P Safety Network

Greater Houston STEPS

IAPX

Mid-Continent EPS-Oklahoma (MCEPS)

North Texas STEPS (NTEPS)

PEC

Permian Basin STEPS/Hobbs NM

Stout Texas STEPS

Other (please specify)

OSHA Safety Stand Down Commitment Form: Oil & Gas 2013

Question Title

* 1. CONTACT INFORMATION:

Question Title

* 2. NUMBER OF JOBSITES INSPECTED:

Question Title

* 3. NUMBER OF HAZARDS IDENTIFIED AND CORRECTED:

Question Title

* 4. NUMBER OF WORKERS TRAINED:

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* 5. NUMBER OF SUBCONTRACTORS INCLUDED IN THIS REPORT:

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* 6. HOW DID YOU FIND OUT ABOUT THE STAND DOWN?

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* 7. IF YOU FOUND OUT THROUGH A STEPS NETWORK WHICH ONE?

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* 8. HOW CAN WE IMPROVE FUTURE INITIATIVES?

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* 9. OTHER SIGNIFICANT ACCOMPLISHMENTS DURING STAND DOWN: