CALL
For natural gas emergencies, call 911 and Unitil at:
MA: 866-542-3547 ME: 866-900-4460 NH: 866-900-4115
For electrical emergencies, call 911 and Unitil at:
888-301-7700
2. Number of employees (including owner): 0-5 6-10 11-20 21-50 51+ NA
3. What is your primary business? (Check all that apply.)
Agriculture
Carpentry
Cement/Concrete and Masonry
Construction
Cranes and Derricks
Drilling (Water, Well)
Electrical
Equipment Rental
Excavation
Farming
Farm Labor Contractor
Farm Supply Services
General Contractor
HVAC
Landscaping
Mechanical
Nursery
Painting
Paving
Plumbing
Remodeling/Additions
Road Construction
Roofing/Siding
Telecom/Cable
Tile Plowing
Tree Trimming
Utility Work
Window Cleaner
Other (please explain):
4. How will you use these safety materials? (Check all that apply.)
Safety meeting/training
Tailgate/job site meeting
New employee orientation/training
Personal knowledge
Customer knowledge
5. What do you feel are the most important safety topics that need to be covered in training materials?
6. How much do you agree with each of the following statements?
7. Years company has been in business: 0-5 6-10 11-20 21-50 51+
8. Is there another language that would be beneficial to have the materials in?
Internal Use Only
ID
BRC Code
Date (mm/dd/yy)
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