Check the box for each of the following programs/policies that have been implemented at this company.

Leave the box unchecked for each program/policy that has not been implemented at this company.

• A safety officer conducts safety inspections on all projects.

• Have implemented 100% fall protection.

• Can provide a site-specific program addressing fall hazards in your work.

• New employee safety training.

• Disciplinary program for safety violations

• Accident/incident investigations

• Workplace sexual harassment training

• Affirmative action plan for employees

• Review the safety management system of subcontractors

• Require employee to be subject to project-specific substance abuse screening

• Written safety program/policy

• Written disciplinary policy

• Annual safety goals

• Return to work/light duty program