Page 25 - Occupational Health & Safety, November 2017
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FREE INFORMATION
November 2017
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N1711F
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BUYING PLANS SURVEY
813 ❏ Hearing Protection
814 ❏ Heat Stress
845 ❏ Industrial Hygiene
815 ❏ Instrumentation/ Monitoring Equipment 841 ❏ Laboratory Services
816 ❏ Lockout/Tagout
837 ❏ Material Handling
840 ❏ MSDS Software
817 ❏ Personal Protective Apparel 818 ❏ Plant Maintenance
819 ❏ Respiratory Protection
820 ❏ Safety Incentives
850 ❏ Safety Monitoring
821 ❏ Security
838 ❏ Signs & Signals
822 ❏ Software
823 ❏ Training
846 ❏ Welding
824 ❏ Workers’ Comp/Risk Mgmt
1. Which of the following product(s)/services do you plan to purchase in the next 12 months?
(Select all that apply)
836 ❏ AED’s
800 ❏ Confined Space
801 ❏ Consulting Services 844 ❏ Continuing Education 802 ❏ Drug & Alcohol Testing 803 ❏ Emergency Response 804 ❏ Ergonomics
805 ❏ Eye & Face Protection 806 ❏ Fall Protection
807 ❏ Fire Safety
808 ❏ First Aid
809 ❏ Foot Protection
847 ❏ FR Fabrics
839 ❏ Gas Detectors/Monitors 810 ❏ Hand Protection
811 ❏ Hazmat Handling
812 ❏ Head Protection
2. What is your projected budget for the selected products/services?
(Select one)
825 ❏ Under $50,000
826 ❏ $50,000-$99,999
827 ❏ $100,000-$249,000 828 ❏ $250,000-$499,999 829 ❏ $500,000-$999,999 830 ❏ $1,000,000-$2,000,000 831 ❏ Over $2,000,000
3. How immediate is your need for the selected products/services?
(Select one)
832 ❏ 0-6 months
833 ❏ 7-9 months
834 ❏ 10-12 months 835 ❏ Over 12 months
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Signature (Required)________________________________________________________ Date __________________________
1. Important: Which of the following products, if any, do you recommend, select and/or buy in your job? (check all that apply)
01 ❏ Safety Equipment
02 ❏ Industrial Hygiene
03 ❏ Training
04 ❏ Software
05 ❏ Emergency Response 06 ❏ Security
07 ❏ Fire Protection
08 ❏ Occupational Health
09 ❏ Environmental Compliance 10 ❏ Ergonomics
90 ❏ None of the above
2. Please indicate ALL functions for which you are responsible:
01 ❏ Safety
02 ❏ Executive Mgmt./Administration
03 ❏ Production/Operations 04 ❏ Facility Management 05 ❏ Engineering
06 ❏ Purchasing
07 ❏ Security/Fire Protection
08 ❏ Industrial Hygiene/Environment 09 ❏ Personnel Management
17 ❏ Risk Management
10 ❏ Emergency Planning
11 ❏ First Responder
12 ❏ Law Enforcement
13 ❏ Safety Product Distributor Medical:
14 ❏ Nurse
15 ❏ Physician
16 ❏ Other Medical Professional
99 ❏ Other (please specify) _____________________
3. Which category best describes the primary end product manufactured or service performed at your business? (check only one)
INDUSTRIAL OR MANUFACTURING:
38 ❏ Oil & Gas Extraction
01 ❏ Mining
02 ❏ Construction/Contracting
03 ❏ Food & Beverage Products
04 ❏ Tobacco Products
05 ❏ Apparel & Other Textile Products
06 ❏ Lumber & Wood Products
07 ❏ Furniture & Fixtures
08 ❏ Paper & Allied Products
09❏ Printing&Publishing
10 ❏ Chemicals & Allied Products
11 ❏ Petroleum & Coal Products
12 ❏ Rubber & Misc. Plastic Products
13 ❏ Leather & Leather Products
14 ❏ Stone, Clay & Glass Products
15 ❏ Primary Metal Industries
16 ❏ Fabricated Metal Products
17 ❏ Industrial Machinery & Equipment
18 ❏ Electronic & Other Electric Equipment
19 ❏ Transportation Equipment
20 ❏ Instruments & Related Products
21 ❏ Miscellaneous Manufacturing Industries 22 ❏ Utilities/Waste Management
23 ❏ Transportation & Warehousing
SERVICE INDUSTRIES:
24 ❏ Wholesale/Distribution
25 ❏ Retail
26 ❏ Financial/Insurance/Real Estate
27 ❏ Professional/Scientific/Technical Services 28 ❏ Health Services
29 ❏ Education Services
30 ❏ Engineering, Research & Related Services GOVERNMENT:
31 ❏ Fire/Rescue/Hazmat/First Response
32 ❏ Law Enforcement
33 ❏ Federal Government 34 ❏ State Government
35 ❏ County Government 36 ❏ City/Local Government 37 ❏ Military
OTHER:
99 ❏ Other (please specify) ______________________
4.Whichofthefollowingproducts/servicedoyou plan to purchase in the next 12 months and would like more information on? (check all that apply)
01 ❏ Emergency Response
02 ❏ Hazmat Handling 03 ❏ First Aid
04 ❏ Protective Clothing 05 ❏ Hand Protection 06 ❏ Foot Protection
07 ❏ Fall Protection
08 ❏ Head Protection
09 ❏ Eye & Face Protection
10 ❏ Hearing Protection
11 ❏ Safety Incentives
12 ❏ Respiratory Protection
13 ❏ Training Software
14 ❏ Workers’ Comp Insurance
15 ❏ Ergonomics
16 ❏ Instrumentation/Monitoring Equipment 17 ❏ Plant Maintenance
18 ❏ Gas Detectors/Monitors
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