The Greater Cleveland Safety Council — Hanna Building — 1422 Euclid Ave. Suite 327 — Cleveland, OH 44115-1901 Voice: 216-621-0059 — Fax: 216-621-0062 — Secure Contact Form

Ohio Safety Council: New Enrollment Form
Each Company Must Complete this Form to participate even if you are in the current program

In an effort to reduce the number of workplace accidents and to share resources and information on accident prevention, risk management and workers’ compensation in Ohio, the BWC’s Division of Safety & Hygiene and your local safety council co-sponsor this program.

In digitally signing this enrollment form, the employer makes a commitment to send representatives to the majority of safety council meetings and to submit semi-annual reports by the deadline dates.

Company Name: (The name that you will be participating in the program as)
Address (including City and Zip Code)
Average Number of Employees (include full & part time)
Type of Work (please be specific)
BWC Policy Number (this is also known as your risk number) If you have more than one risk number each must be enrolled separately to participate
OSHA SIC CODE Click Here to look up your code
Enrollment Year
Contact Person's Name
Contact Person's Phone
Contact Person's Email
Title
Electronic Signature Please type your name and today's date
Name of the Chief Executive Officer or Highest Ranking Authority

 

 

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