By visiting your plant or manufacturing facility...
and conducting an in-depth review of your production processes, we can identify the hazards now affecting both your workers and your cost of doing business. Each Plant Evaluation concludes with a comprehensive Action Plan to manage those threats.

To help us serve you, please complete this form in detail. One of our qualified people will call you to set up an appointment.

Please tell us about yourself

Name

First                                                  Last

Company

Position

Street

Town/City

State/Province

Zip/Postal Code

Country

Your Website

Phone
(###) ###-####
extension:

Fax

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EMail

 

Please tell us about your company

How did you find out about the Impacto Web Site?

Other

For your company, do you have a person or comittee who handles plant safety issues?

If you do, how often do they dedicate time for this?

Number of People Employed in Your Company:

Does your company currently use any other protective products?

Yes No

If Yes, which company's products do you now use?

How often do you buy new safety gloves and wrist protection products?

How often does your company evaluate each worker's work situation?

How often does your company do a functional capacity evaluation (FCE) -- determining a person's physical limitations to get them back to work at their regular or a modified position?

What type of pre-existing conditions are you most concerned about at your company?

How many of these kinds of injuries have you had at your company in the last year?

What work related injury prevention issues do you want to address the most?

Are you planning a possible change to your plant safety situation right away? If this is...

URGENT for you, please click this checkbox and we will phone you to set up an evaluation right away.

Urgent

If you are planning a possible change to your plant safety situation SHORTLY, please click this checkbox and we will contact you by e-mail.

Shortly

Do you wish to receive Industrial Safety News from Impacto?

Yes No

What is the best time to contact you?

Please enter any additional information you require to make a decision about having us do an evaluation at your plant.