Page 17 - OHS, May 2021

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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
FREE INFORMATION
May 2021
Card expires July 2021
Reader Service Card
N2105F
For FREE information, circle the Reader Service Number on the card below, or go to www.ohsonline.com Please type or print clearly and answer all the questions on the card.
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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o YES, I would like to receive/continue to receive Occupational Health & Safety. o NO.
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
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
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) _____________________
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Name ______________________________________ Title _________________________________________ Company __________________________________________________________________________________ Address _________________________________________________________________ o Home o Bus. City_______________________________________State ________________ Zip _________________ Zip+4____________ Email address ________________________________________________________________________ Business Phone (_______) ________________________ Fax (_______) ________________________________
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