Fill and Sign the Compliance Survey Form

Compliance Survey We are committed to eliminating wrongful, unsafe and unethical conduct. It is never in a company’s best interest to have managers or employees violate laws, policies, safety or ethical standards. When properly used, this survey will allow us to maintain a trusting work environment and avoid unnecessary claims. If you have any comments regarding the use or improvement of this survey, please let us know. Thank you. Please complete the following questions: 1. Do you understand that our company does not tolerate sexual harassment, discrimination, safety violations, and ethical misconduct? Yes No 2. Do you understand your ability to complain about unfair conduct, including anything related to harassment, discrimination, safety or ethics? Yes No 3. Do you understand that you are required to report the violation of company policies? Yes No 4. Are you aware of, or have you witnessed, or have you been a victim of, the violation of any company policy, including those prohibiting sexual harassment, discrimination, safety violations, or ethical misconduct? Yes No 5. Have you reported any and all workplace injuries by completing an Injury Report? Yes No 6. Is there any personnel, compliance, ethics or safety issue(s) you have a question about or would like to discuss? Yes No I declare the above to be true and correct pursuant to the penalty of perjury of the laws of the State of ____________________ . _________________________ Signature of Employee _________________________ Print Name _____________ Date