Stand-Down Activity Follow-up

This survey is being used to gather information on successful activities conducted as part of the National Campaign to Prevent Falls in Construction and the associated National Safety Stand-Down on June 2 – 6, 2014. Individual contact names and email addresses will be kept confidential by CPWR and will only be used in the event that additional information related to activities described is needed. Any other information provided, including company name, may be used to write a Success Story or report, which would be shared publicly via stopconstructionfalls.com and/or any of CPWR’s websites and other campaign-related outreach efforts. Any Success Story or report describing an effort will be provided to the company contact for approval prior to publication.

All information except for individual contact names and email addresses, including company name and jobsite, will also be shared with our major campaign partners – The Occupational Safety & Health Administration (OSHA) and The National Institute for Occupational Safety & Health (NIOSH).

The survey is completely voluntary. By submitting the survey, you are consenting to use of the provided information by CPWR, OSHA, and NIOSH for data collection purposes, and with further approval, publication. If at any point you decide not to have your activities published, you may contact CPWR and we will remove the content from publication.

Question Title

* 1. Company Name:

Question Title

* 2. Contact Name:

Question Title

* 3. Contact Email Address:

Question Title

* 4. Jobsite Name(s) or Location(s):

Question Title

* 5. How many people participated in the Stand-Down activities?

Number of Contractors:

Number of Workers:

Number of Safety Professionals:

Question Title

* 6. What activities were conducted? (Check all that apply)

Toolbox Talks

Videos

Handouts

Media outreach/press release

Newsletter article(s)

Email blast

Social media posting (Facebook, Twitter, etc.)

Billboard(s)

PSA

Transit posters

Presentations

Safety training for workers

Public safety training

Equipment inspection

Emergency response drill/training

Worked with partners.

Other (please specify)

Stand-Down Activity Follow-up

Question Title

* 1. Company Name:

Question Title

* 2. Contact Name:

Question Title

* 3. Contact Email Address:

Question Title

* 4. Jobsite Name(s) or Location(s):

Question Title

* 5. How many people participated in the Stand-Down activities?

Question Title

* 6. What activities were conducted? (Check all that apply)

Question Title

* 7. Is there anything more you would like to report, or any details you can provide on the activities you indicated above?

Question Title

* 8. How did you hear about the National Safety Stand-Down?

Question Title

* 9. Based on observation or feedback you received, what activity worked best, or resonated most with your audience?