1. Brief description of site/location (e.g. Acme Inc. is a research and development site focusing on...)

2. What is the total headcount at your site/location, the headcount of company employees, and the headcount of non-company employees (contractors, vendors, etc..)?

3. What is the estimated percentage of company employees that perform potentially hazardous work  (for ease of estimation disregard safety controls in place). This may be an estimate of the % of people for example in maintenance, handling of chemicals, electrical work, etc.)

4. What is the number of safety/IH staff specifically supporting site/location (if possible/needed clarify using full time equivalents - FTE - and if number includes off-site workload considerations).  
   FTE example:  Acme Inc. ABC site has 1.8 FTE  = one employee is 0.7% site focused, one employee is 0.9% and one employee is 0.2%; or  Acme Inc. ABC site has 3 employees 2 employees work 50% on environmental and 50% safety and one employee is 100% safety so it would be .5 + .5 + 1= 2 FTE).  What is the number of administrative (e.g. technician or administrative/office personnel) and professionals?  How many are contractors and how many of these are company employees? (Please exclude consulting, project orientated safety professional use.)

5. What is your lost work days due to injury/illness (or OSHA rate).  
   
   If available, what is your company's latest Experience Modification Factor (EMF - used to be EMR) rate?

6. What are the top three things that you spend your budget on (e.g. head count, sampling analysis, measurement tools, PPE, etc...)

7. What are your top 5 most challenging issues at this time and/or in the next 5 years?

8. May we contact you for a follow-up discussion?

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