Name (optional):

Gender:

Age:

Education:

Mobile No:

Email:

Overall years of Experience:

Current company name (optional):

Current company nature of work:

Number of employees:

Years of Experience in the same company:

Job Title & Nature of Work:

Is there an OSH officer at work? How many

What OSH training did you receive? When? How frequent is refresher training?

Were you consulted on any OSH topic? What was it?

Did you participate in the incident investigation? explain