On-Site Consultation Request Form
for Private Businesses in New Jersey

NJDOL/OSHA On-Site Consultation offers occupational safety and health consultations to assess safety management systems, identify hazards, and provide training to help prevent accidents, injuries, and fatalities. These consultations are free to private employers in New Jersey. Establishments with low rates of injuries and illnesses may even qualify for a safety recognition award.

An OSHA On-Site Consultation is a confidential service that is completely separate from OSHA enforcement; consultants do not issue citations or impose penalties. Employers are, however, obligated to correct serious hazards that the consultant identifies within a mutually-agreeable timeframe.

Please email njonsite@dol.nj.gov for further information.

If you are a public sector employee seeking consultation, please complete this form.

OSH-206

Request Date

Contact Name

Contact Title

Contact Email Address

Establishment Name

Website

Location Address

Mailing Address

Telephone Number

Ext.

Fax Number

Type of Business

NAICS Code If you do not know your Code, please use the US Census Bureau’s website (https://www.census.gov/naics/?99967) or enter NAICS code listed on your previous year OSHA 300A Form.

Number of employees at this site

Number of employees covered by this request

Total number of employees at all sites in USA

Is the establishment to receive services unionized? Value is not selected

Date of last OSHA inspection

Additional Information

Does your company utilize temporary workers? Value is not selected

How did you find out about the on-site consultation service? Value is not selected

Please specify.

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Safety and Health - Consultation & Training Request Form

Additional Information