Slip Trip and Fall Initial Questionnaire This is the initial questionnaire for the Slip Trip and Fall Course Company InformationCompany Name(Required)Address(Required) Street Address City State / Province / Region ZIP / Postal Code Company Phone(Required)Type of Business(Required)What is the maximum number of employees.(Required)This is the maximum number of employees (part-time or seasonal) you would have during the year.Safety Coordinator(Required) First Last Safety Coordinator Email(Required) Safety Coordinator Phone(Required)Building Constructed Date(Required)Do you have the OSHA poster? Yes No Does anyone speak secondary language?(Required) Yes No Language(s)Were there any injuries within the last year due to a slip or trip?(Required) Yes No InjuriesLocationDescriptionHow corrected Add RemoveDuring this inspection were there any slipping hazards observed?(Required) Yes No Slipping hazardsLocationDescriptionHow corrected Add RemoveDuring this inspection were there any tripping hazards observed?(Required) Yes No Tripping hazardsLocationDescriptionHow corrected Add Remove
