Health & Safety Legal Compliance Submission Form
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]
