Section 1 of 6 in this document
IOSHA Request to Participate in Cooperative Program
Partner with IOSHA!
Type of Cooperative Program
Alliances
Partnership Program
Voluntary Protection Program
Employer Information
Employer Name
*
First Name
*
Last Name
*
Phone Number
Fax Number
Email
*
Section 2 of 6 in this document
Employer Address Information
Worksite Address(es)
Section 3 of 6 in this document
Project Information
Project Description
*
Section 4 of 6 in this document
Employer Demographic Information
Total Number Employees at Primary Site
*
Total Number of Employees Nationwide
*
NAICS Code/Business Type
*
Find your NAICS code on this website.
Section 5 of 6 in this document
Additional Questions
Have you had an OSHA enforcement visit in the last 12 months?
Yes
No
Union Representation
Yes
No
Union Name
*
Name of Union Contact
*
Phone Number
Union Contact Address
Street Address
City
State
Zip
disregard this