BASIC INITIAL HEALTH & SAFETY ASSESSMENT SUBMISSION

ONLINE SUBMISSION IS ONLY FOR BASIC INITIAL HEALTH & SAFETY ASSESSMENTS

Do not submit ANY OTHER DOCUMENT.(S) REVIEW & VERIFY ASSESSMENT HAS BEEN COMPLETED CORRECTLY, PRIOR TO SUBMITTING ONLINE. INCOMPLETE OR INCORRECT BASIC INITIAL HEALTH & SAFETY ASSESSMENT WILL BE RETURNED.

For further instructions on how to submit it online, please review instruction sheet





*denotes required field

ATTACH BASIC INITIAL HEALTH & SAFETY ASSESSMENT only (required*)
Please submit HEALTH & SAFETY ASSESSMENT for only one individual per submission
.jpeg and or .pdf files only

IF THE BASIC INITIAL HEALTH & SAFETY ASSESSMENT IS NOT COMPLETED WITH 100% ACCURACY & COMPLETENESS, YOU (PRIMARY CAREGIVER / DIRECTOR) WILL BE NOTIFIED BY EMAIL OR BY TELEPHONE TO REVIEW THE QUESTIONS THAT WERE ANSWERED INCORRECTLY.

The confirmation email that you receive will be dated with the day PATCH received your assessment. If assessment is correct your training period will then start. (Ie. received email on 4/15/2021 than you training period would be 4/15/2021-4/14/2022).

Disclaimer: IF ANY BASIC INITIAL HEALTH & SAFETY ASSESSMENT SUBMITTED IS ILLEGIBLE OR ALTERED, PATCH WILL CONTACT YOU & REQUEST THAT YOU MAIL THE ORIGINAL BASIC INITIAL HEALTH & SAFETY ASSESSMENT TO BE PROCESSED.