Certificate of Participation
Thank you for joining thousands of employers in the 2016 Fall Prevention Stand-Down. This certificate of participation is yours in recognition of the time and effort you devoted to talk about preventing falls with your crew. Of course, every day should be fall prevention day, so I challenge you to build on the steps you took today. I hope you will keep talking to your workers and dedicating yourself to preventing falls at your worksites.
Thomas E. Perez
Secretary of Labor
To print a certificate for your business's participation in the Stand-Down, please fill out the information below. Once you submit this information, a printable PDF document will appear for you to enter your business name and project title. We also hope that you will help us by answering a few optional questions about your Safety Stand-Down and giving us feedback on our campaign. Please note that you are not required to request a certificate and that if you choose to do so OSHA will not use the information or feedback you provide for any purpose other than evaluating the Stand-Down campaign and planning future outreach efforts. Also note that the certificate does not represent an assessment of compliance with OSHA standards at your worksite(s).
OMB Control Number 1225-0088
Expiration date: 08/31/2017
PAPERWORK REDUCTION ACT
Public reporting burden for this voluntary collection of information is estimated to average 10 minutes per response, including time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. OSHA will use this information to evaluate the National Fall Prevention Safety Stand-Down. Persons are not required to respond to the collection of information unless it displays a current valid OMB control number. If you have any comments about this estimate or any other aspects of this data collection, including suggestions for reducing this burden, please send them to OSHAPRA@dol.gov or to US Department of Labor, OSHA Directorate of Standards and Guidance N-3609, 200 Constitution Avenue, NW, Washington, DC 20210.