Virtual Compliance Assistance Form

The Georgia Tech OSHA Consultation Program is operational, but as of March 16, 2020, our staff is working on a virtual basis. We are not conducting on-site consultation visits, but if companies would like virtual assistance during this time, please complete this compliance assistance form. Please contact us via phone or email with any questions. Any fields indicated with an * is a required field. You will not be able to submit the form unless all fields are answered.

1. Company Name

2. Mailing Address

3. Name, title & contact information of person making request

4. Contact person (If different from one making request)

5. Has Georgia Tech provided Safety/Health Consultation Services before?

6. What type of virtual compliance assistance would you like provided:

7. How would you like to conduct the virtual compliance assistance:

8. Briefly describe operations performed, flow processes, machinery or equipment used, and FINAL PRODUCTS:

9. Identify which technical programs you currently have in place:

10. Identify below the aspects you consider to be areas of concern:

11. Employee Information

12. Have you had an OSHA Inspection?

13. Was this request the result of a settlement agreement with OSHA?

14. How did employer learn of Georgia Tech's program?

15. Are you involved in an active partnership or alliance?

16. Signature