Health & Safety Legal Compliance Submission Form
Please fill out all sections of the form accurately. Attach all relevant documents in Section 3 and if any section is not applicable, please indicate N/A.
I. Company Information
Company Name | [Your Company Name] |
Date of Submission | [Month Day, Year] |
Contact Person | [Your Company Address] |
Contact Email Address | [Your Company Email] |
Contact Phone Number | [Your Company Number] |
II. Compliance Details
Field | Description |
Compliance Category | [Workplace Safety Compliance] |
Compliance Regulation ID | [OSHA 300] |
Description of Compliance | This compliance relates to the adherence to the Occupational Safety and Health Administration (OSHA) standards for workplace health and safety. I |
Compliance Date | [MM-DD-YYYY] |
Next Review Date | [MM-DD-YYYY] |
III. Compliance Evidence
Field | Description |
Document Title | Annual Workplace Health and Safety Audit Report [YEAR] |
Document Type | (e.g., Audit Report, Training Record) |
Document Date | [MM-DD-YYYY] |
Document Summary | This document is the annual audit report for the year [20xx], detailing the findings of the workplace health and safety audit conducted on [MM-DD-YYYY]. |
IV. Action Plan (If Non-Compliant)
Field | Description |
Issue Identified | During the routine inspection, it was identified that the emergency exit routes in the warehouse section were partially obstructed due to unmarked storage boxes, which is a violation of OSHA's egress standards. |
Corrective Action | To rectify this issue, all obstructing objects will be immediately removed from the emergency exit routes. |
Responsible Person | [Secondary Party’s Name] |
Completion Date | [MM-DD-YYYY] |
Follow-Up Date | [MM-DD-YYYY] |
V. Declaration
I hereby declare that the information provided in this submission is accurate and complete to the best of my knowledge.
[Your Name]
Position: [Position/Role in the Company]
Date: [MM-DD-YYYY]
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