DOLI – Virginia Department of Labor and Industry

Company Name(Required)

Type of Business(Required)

Point of Contact

Title(Required)

Email(Required)

Phone(Required)

Employee Information

Number of employees at this location:(Required)

Total number of employees in your U.S. entity:(Required)

A Safety survey will focus on fire, mechanical, electrical, material handling, and working surfaces.

A Health survey will focus on chemical safety, personal protective equipment, bloodborne pathogens, and exposures to noise, heat, and air contaminants.

VOSH Consultation Page DRAFT

VOSH Consultation Request Form

Point of Contact

Employee Information

Additional Information