General Products & Services Survey
Floor Survey
Safety Survey

Safety Survey

Contact Information
Name
Company Name
Address
City
State
Zip
Phone
Fax
e-mail
Safety Information
1. Do you have an: Industrial Hygienist - Safety Director - Safety Engineer on site? Yes No
	If yes, please indicate job title and name.
2. Any unusual conditions or environment to be considered?
3. What safety information or safety training are you now using?
4. Do you have safety training scheduled? Yes No
	If yes, how frequently?
5. What safety information or safety training is needed?
Product
1. What safety products do you currently use?
2. What do you like most about the safety products you are currently using?
3. What would you like to see improved with any of your present safety products?
Service
1. What do you like most about your present supplier?
2. How could your needs be better served?
3. IPA is able to offer products and services as a dual function. How can we work together to do this?
4. Are new safety products and services approved by you or other individuals? If other individuals please indicate name and title.
5. IPA can help you comply with your Material Safety Data Sheet requirements. How can we work together to do this?

To learn more about how IPA can assist you and your company with your industrial paint and abrasives needs, please contact us. You won't find a more responsive company ready to serve you with the best customer service in the industry.