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Industrial Commission of Arizona

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Industrial Commission of Arizona
Protection of life, health, safety, and welfare of Arizona's workforce

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  • Home
  • Agency Information
    • About Us
    • Commissioners
    • Director's Office
    • Legislation
      • Arizona Statutes
      • Arizona Rules
    • Meetings
      • All Public Meetings
      • Commission Meeting Agendas
      • Meeting Minutes
  • Divisions
    • Administration
      • Accounting
      • Human Resources, Special Services and MIS
      • Self-Insurance and Tax Office
    • Administrative Law Judge (ALJ) Division
    • ADOSH
      • Boiler Section
      • Elevator Section
      • Occupational Safety and Health (OSHA / ADOSH)
      • Research & Statistics (BLS)
    • Claims Division
    • Labor Department
    • Legal Division
    • Medical Resource Office (MRO)
    • Special Fund Division
  • News and Events
    • Public Notices
    • News and Events
  • Resources For
    • Resources for Employees
    • Resources for Employers
    • Resources for Insurers
    • Resources for Medical Providers
    • Resources for ICA Community
  • How Do I
  • Online Services
    • Forms
    • Self Service Center
    • ICA Community
  • Payment Portal
  • OMBUDSMAN
  • Home
  • VPP Pre-Screening Form

VPP Pre-Screening Form

Instructions

ADOSH requires all new VPP Star candidates to fill out a pre-screening form. The form is used to provide the ADOSH Compliance Assistance Team with information related to your workplace. It also provides valuable information related to your injury and illness rates which is the starting point to determine if you qualify for the exemplary program. Once filled out and submitted, someone from the Compliance Assistant Team will reach out to schedule a meeting to discuss your site and develop a plan for action.

Sign and Submit Form

ADOSH VPP PreScreening Form 202106

Printer-Friendly Form

PDF icon ADOSH VPP PreScreening Form.pdf

Related Forms

Report a Fatality or Severe Injury Form
Notice of Alleged Safety or Health Hazards Form
Discrimination / Whistleblower Complaint Form
Consultation Request Form
ADOSH Training Request Form
Application for Permit to Install or Alter Elevator Form
Elevator Inspection (PEI) New Application
Request for Boiler Repair Form
Request for Boiler Certificate Form
Boiler Inspector (PBI) Renewal Application
Compliance Assistance Request Form
VPP Pre-Screening Form
SHARP Application Form

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Phoenix AZ 85007
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