Welcome to the Compliance Advantage Program! Please fill this form out as completely as possible. We need this information to customize your OSHA manual. Please call 817-755-0035 if you need assistance!

Practice Name

Order Number from Invoice

Address

Address 2

City

State

Postal Code

Emergency Contact Number

OSHA Safety Coordinator

Name of Person in charge of SDS

Location of OSHA manual

Location of SDS

Practice County

Let's talk about Exposure Control. You will need to identify a clinic that can handle an Exposure Incident. If you would like us to recommend one, please check the box below and skip to the next section. If you have a clinic identified already, please enter the information below.

Would you like us to help you find a post-exposure clinic

Post Exposure Clinic

Post Exposure Clinic Address

More OSHA Information

List your EPA approved disinfectants

Eyewash Location

Location of Designated meeting place outside your practice for emergencies

Clinic for Employee Hep B Vaccinations

Use Nitrous Oxide?

Does office use formaldehyde based products?

# of Active TB patients seen last 12 months

Location of Employee First Aid Kit