ADOSH - CONSULTATION - Survey Request Form

Instructions

An employer may request a free consultation visit for a facility or workplace location.  This form can be used to make this request. The consultation visit is purely voluntary and can be cancelled before or during the visit.   Hazards identified by the consultant will not result in citations or penalties; however, they must be fixed within an agreed upon time period.  Following the visit, the consultant will prepare a detailed report and send it to the employer electronically or by mail.

This form can be submitted online or it can be submitted to ADOSH by mail, fax, or hand-delivery.

For more information, contact ADOSH toll free at (855) 268-5251 or (602) 542-5795 (Phoenix) or (520) 628-5478 (Tucson).

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