Workplace Safety OSHA Form

Workplace Safety OSHA Form

Employer and Site Identification

Recitals

WHEREAS, Employer Name: operates the workplace identified above and seeks to evaluate and remediate workplace hazards in accordance with applicable workplace safety standards; and

WHEREAS, Service Provider Name: possesses expertise in occupational safety inspections, hazard assessments, employee training, and corrective action planning; and

WHEREAS, the parties desire to set forth the scope, duties, payment terms, confidentiality, and other material terms for services to be provided at the Site.

Scope of Work

Service Provider shall perform the following services at the Site. The work shall include hazard identification, inspection, written reports, recommended corrective actions, and training as specified below.

Hazard Identification / Checklist

Indicate observed or potential hazards at the Site. Check all that apply and provide specifics in "Other" where necessary.

Incident Summary (if applicable)

Provide a concise summary of any incident(s) observed or reported that relate to the hazard(s) above.

Corrective Action Plan

Responsible party shall implement corrective actions to abate identified hazards. Provide assignments, target completion dates, and verification steps.

Training and PPE

Indicate trainings provided and personal protective equipment issued to employees at the Site.

Inspections & Monitoring

Payment Terms

Compensation for the services described herein shall be as follows:

Term and Termination

This Agreement commences on Start Date: and continues until End Date: unless earlier terminated pursuant to this section.

Either party may terminate this Agreement for convenience upon written notice delivered at least days prior to the effective termination date. Termination for cause may be immediate for material breach that is not cured within a commercially reasonable cure period.

Confidentiality

Each party shall treat as confidential all non-public information obtained in connection with the services, including inspection reports, corrective action plans, employee medical information, and trade secrets. Confidential information shall not be disclosed to third parties except as required by law, to legal counsel, or to governmental regulators in the performance of lawful duties. The receiving party shall use at least the same degree of care to protect confidential information as it uses for its own confidential information, but in no event less than reasonable care.

Insurance and Liability

Service Provider shall maintain insurance appropriate to the scope of services, including general liability and workers' compensation where applicable. Except for willful misconduct or gross negligence, neither party shall be liable to the other for indirect, incidental, or consequential damages. The parties' aggregate liability for direct damages shall be limited to the fees paid under this Agreement for the services giving rise to the claim.

Governing Law

This Agreement shall be governed by and construed in accordance with the laws of the State specified below, without regard to conflict of laws principles.

Entire Agreement

This document, together with any appendices, statements of work, or written change orders signed by both parties, constitutes the entire agreement between the parties regarding the subject matter hereof and supersedes all prior agreements, understandings, and representations, whether written or oral.

Acknowledgment and Certification

The undersigned certify that they are authorized representatives of their respective parties, that the information provided herein is true and accurate to the best of their knowledge, and that they agree to comply with all applicable workplace safety laws and to cooperate in the implementation of corrective actions.

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