OSHA Consultation Services Request

On-Site Safety & Health
Consultation Application

Please complete this form accurately to ensure we are able to provide the most effective consultation tailored to your company's needs. Remember to hit the "submit" button at the bottom of the page to make sure your information is received.

If you need help or have any questions while completing this form, please contact us at (405) 521-6141 or email jahkia.robinson@labor.ok.gov.

Company Name:
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Company Email:
Please enter a valid email
Website:
Mailing Address:
Street*
City/Suburb
State*
Zip/Post Code*
Country*
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County:
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Site Street Address (if different from mailing):
Street*
City/Suburb
State*
Zip/Post Code*
Country*
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County:
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Primary Contact's Name:
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Primary Contact's Title:
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Primary Contact's Email:
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Primary Contact's Phone:
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How did you learn of our service?
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Briefly describe your company's operations and final products. If more than one operation, list in primary order.
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NAICS or SIC Code:
This question is required
Are you a construction company?
Yes
No
Please choose an answer
Commercial
Residential
Hwy/Bridge/Road
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Type of consultation/inspection:
Safety
Health
Both Safety & Health
SHARP
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Service requested:
Full
Limited
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Specific requests:
Is the facility:
Union
Non-Union
This question is required
Union Local Number:
# of employees at this location:
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# of employees corporate wide:
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Have you had an OSHA Compliance visit in the past 12 months?
Yes
No
Please choose an answer
Are any of the following used in the production processes at your facility? (Check all that apply)
Flammable/Combustible Liquids
Mechanical/Hydraulic Power Presses
Welding/Cutting Processes
Confined Space
Cranes
Machining (cutting, shearing, forming)
Sources of Radiation/Lasers/High Magnetic Fields
Noise Levels
Dip Tank Operations
Spray Finishing/Coating/ Blasting
Lockout Tagout
Other
This question is required
Are any of the following present at your facility? (Check all that apply)
Lead
Combustible Dust
Silica
Isocyanates
Hexavalent Chromium
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