Certificate of Participation (English and Spanish)

Thank you for joining thousands of employers in the 2022 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 employees and dedicating yourself to preventing falls at your worksites.
Sincerely,
Scott Ketcham, Director
Directorate of Construction

NOTICE: The Fall Prevention Stand-Down certificate will download as a PDF. It is recommended that you complete this form on a desktop or laptop computer with a screen resolution set at a MINIMUM of 1280 x 768 and the browser is maximized on the screen.

To download a certificate for your business's participation in the Stand-Down, please fill out the information below. Once you submit this information, you will receive a certificate (a printable PDF document will display) with your business name, project title and level of participation (depending on the number of years of participation). 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).

Please Indicate if you give the Agency consent to use your comments in our program assessment and promotional activities.

Please Indicate if you give the Agency consent to use your comments in our program assessment and promotional activities.

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OMB Control Number 1218-0271

Expiration date: 6/30/2022

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.