OhioBWC - Employer - Service: PERRP Request for Service

PERRP Request for Service

I would like to request the Public Employment Risk Reduction Program, to conduct a "free" consultation of our facility.
NOTICE: For Government Employers Only - Public employers, such as government agencies, public authorities such as counties, townships, or cities, and other public employers such as school districts.
* indicates required field

We would like to have a (choose any combination of at least one of the following): 
* Safety Survey         Health Survey
* Number of Employees:  
* Number of Buildings:  
* Contact Person:
* Name of Agency:
* Telephone Number:
City,State,Zip (+4):  OH
* County:

Please check below areas of interest:  
Other Services Industrial Hygiene

Program Review Indoor Air Quality Surveys
Site Specific Evaluations Noise Monitoring
  Chemical Exposure Air Monitoring
Description of area to be evaluated:
Other not listed (please specify):  
* indicates required field