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Site Evaluation Form
Please provide as much information as you have available, to help us better understand your site.
First Name
*
Last Name
*
Email
*
Phone number
*
Company Name
*
Site Address
Key problem areas that need addressing:
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What are the 3 most important things to you in this project?
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Number of staff and forklifts on site
What has prompted you to reach out?
Internal Review
Incident
New Project
Other reason
Has Worksafe had any involvement or input into these areas?
Do you have a budget or require CAPEX sign-off?
Budget
CAPEX sign off
When do you need the solution in place by?
Day
/
Month
/
Year
Other than yourself who else needs to have input on the project?
If you have any plans, pictures or previous assessments please share them here
Other comments
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