| Company Name: |
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| Your Name: |
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| Your Title: |
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| E-mail Address: |
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| Work Phone #: |
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| Fax: |
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| URL: |
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| Street Address: |
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| City: |
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| Enter City here (ONLY if not in the list above): |
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| Province / State: |
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| Country: |
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| Postal / Zip Code: |
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Please chose your Industry: |
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-OR- |
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Enter Industry here (ONLY if not in the list above): |
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Please Indicate your Area of Interest: |
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Staffing |
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Safety |
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Security |
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Other, Please specify |
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| 1. Does your organization have a Safety and Security Risk Management Program in place to minimize liability? |
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Yes, a formal program |
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Yes, an informal program |
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No, but we plan to implement one within the next 12 months |
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No |
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| 2. Has Safety and Security Risk Management increased in importance in your organization in the last year? |
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Yes |
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No |
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| 3. Which of the following are driving interest and concerns in Safety and Security Risk Management? (Choose all that apply) |
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Regulatory compliance |
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Security threats |
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Business continuity issues |
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Pressure from Senior Corporate Management or the Board of Directors |
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Litigation |
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Other, Please specify |
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| 4. What are the biggest challenges your organization faces in managing safety and security risk? (Choose all that apply) |
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Budget/Cost Restraints |
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Poor Training in Safety and Security Risk Issues |
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Complexity of Extending Initiatives to Contractors |
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Lack of Control over Subcontractors Safety and Security guidelines |
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No Binding Legal Language in Subcontractors Agreements |
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Lack of Safety and Security Risk Management Tools |
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Other, Please specify |
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| 5. Does your organization have any risk assessment products or services? (Choose all that apply) |
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Safety and Security Risk Management Software or Manuals |
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Program Development and Management Software |
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Site Management Software or Manuals |
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Storage and Shipping Compliance Systems |
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Risk Management Consulting Services |
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Other, Please specify |
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| 6. Which of the following Safety and Security risk related challenges has your organization experienced in the last 12 months? (Choose all that apply) |
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Regulatory Fines |
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Legal Action |
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Security Breaches such as Loss of Asset |
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Failed Projects |
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Business Failure of Major Partners |
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Systems Failure that had Measurable Impact on the Business |
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Other, Please specify |
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