Safety Council New Enrollment
In an effort to reduce the number of workplace accidents and to share resources and information on accident prevention, risk management and workers’ compensation in Ohio, the BWC’s Division of Safety & Hygiene and your local safety council co-sponsor this program.
Mail this form to:
1323 4TH Street, NW, New Philadelphia, Ohio 44663
In signing this enrollment form, the employer makes a commitment to send representatives to the majority of safety council meetings and to submit semi-annual reports by the deadline dates. Please fill in all spaces. We do communicate via e-mail.
| Company Name | ____________________________________ |
| Address | ____________________________________ |
| Phone Number | ____________________________________ |
| Fax Number | ____________________________________ |
| Web Site | ____________________________________ |
| E-Mail Address | ____________________________________ |
| Average Number of Emplyees | ____________________________________ |
| Type of Work | ____________________________________ |
| BWC Policy Number | ____________________________________ |
| Enrollment Year | ____________________________________ |
| Name | ____________________________________ |
| Signature | ____________________________________ |
| Title | ____________________________________ |
Tuscarawas Valley Safety Council
Membership Investment Schedule
(Current members of the Tuscarawas County Chamber of Commerce do not pay a separate fee for Safety Council)
| I'm a Chamber Member | Invoice | Check Enclosed |
