Order Free Safety Materials

1. Where should we mail your FREE safety materials?
First Name Required
Last Name Required
Title Required
Company Required
Mailing Address Required
  Check if this is a home address.
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2. Number of employees (including owner):
    0-5    6-10    11-20    21-50    51+

Please make a selection.


3. What is your primary business? (Check all that apply.)

Please make a selection.

4. How will you use these safety materials? (Check all that apply.)

Please make a selection.

5. What do you feel are the most important safety topics that need to be covered
    in training materials?



6. How much do you agree with each of the following statements?

  Strongly agree Agree Neither agree nor disagree Disagree Strongly disagree
Consumers Energy is committed to the safety of workers like me.
The information Consumers Energy provides is valuable for keeping workers safe around electricity and natural gas.
I expect Consumers Energy to provide workers the information necessary to get their jobs done safely around Consumers Energy's electric and natural gas infrastructure.
The workers at my company use the Consumers Energy safety information to work more safely around electricity and natural gas.
The worker materials provided by Consumers Energy help me and/or my coworkers perform their jobs more safely.


7. Years company has been in business:
    0-5    6-10    11-20    21-50    51+


8. Is there another language that would be beneficial to have the materials in?




Internal Use Only


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Date (mm/dd/yy)