Personalize your OSHA Manual

Please complete form below and submit with your order. If an item does not apply to your facility, please put N/A in the form field. If you have questions before filling out this form, please contact us.

To assist you in filling out the form we have created a pdf document that you can save to your computer. This will allow you to print the form and gather all the necessary information so you can fill out the online form quickly and easily. Personalize Your OSHA Manual printable form. pdf

The first section is for your OSHA Manual 1. At the bottom of the page click the "Continue to OSHA Manual 2 Form" button to complete filling out the form for OSHA Manual 2.

OSHA Manual 1
Front Cover
Name:
Name 2:

Title Page
Name:
Address:
Address 2:
City:
State:
Zip:
Telephone: - -
Email address:

Please select your business's industry type:
 
Effective Date of Manual:
Date:      
Management Official (usually the owner or general manager):
Full Name:
Title:
Person Responsible for Injury and Illness Prevention Program (IIPP):
Full Name:
Title:
Direct questions regarding this program to:
Full Name:
Person responsible for OSHA requirements (instructions, communications and coordination of OSHA requirements):
Full Name:
Location of Manual (please be specific):
Location:
Person responsible for General IIPP (plan administrator):
Full Name:
Person responsible for General Office Safety Plan:
Full Name:
Person responsible for Ergonomics Plan:
Full Name:
Person responsible for Fire and Fire Emergency Plan:
Full Name:
Person responsible for Emergency Action Plan:
Full Name:
Person responsible for Hazard Communication Plan:
Full Name:
Person responsible for Exposure Control Plan:
Full Name:
Person responsible for Medical Waste Plan:
Full Name:
Person to receive Reports (regarding injuries, illnesses, exposures, unsafe or unhealthy conditions):
Full Name:
Person last to Evacuate (ensuring facility is empty):
Full Name:
Person employees report to at the Assembly Area:
Full Name:
Number of Exits and their Locations:
Description:
Assembly Area—The assembly area is a designated area away from the facility where all employees go to in the event of an emergency, this allows those in charge to check the well being of each member of the staff and to ascertain if any one is missing. (Be specific):
Location:
Fire Hazards (list each hazard, it's location, and specific fire prevention practice. For example: Gas burner (laboratory) or coffee-maker (kitchen) , turn off when not in use and keep combustibles away):
Description:
Fire Control Measures (list work area and then check appropriate box):
Work Area Portable Extinguisher Fixed System (Sprinkler)
Does your Facility have: Yes No
Smoke Detectors
Carbon Monoxide Detectors
Fire Alarm (if yes, complete alarm info below)
Burglar Alarm (if yes, complete alarm info below)
Alarm Company:
Telephone: - -
Account #:
Fire Department – Call 911 or:
Telephone: - -
Medical Assistance – Call 911 or:
Telephone: - -
Police – Call 911 or:
Telephone: - -
First Aid Provider:
Name:
Location of First Aid Kit (be specific):
Location:
Location of Medical Emergency Kit (if not applicable enter N/A):
Location:
Location of Eyewash (be specific):
Location: