About This Template
Coordinate safety responsibilities among multiple employers on a shared worksite per OSHA multi-employer guidelines.
Fill in each field below with your specific information. Fields marked with an asterisk (*) are required. Replace all bracketed text with your actual details and remove the brackets.
How to Use This Template
- Print this page or copy the template into a word processor.
- Replace each bracketed field with your actual information. Remove the brackets.
- Remove sections that do not apply. Write N/A for required fields that do not apply.
- Review the completed document for accuracy. Check every field twice.
- Have someone else review it before final submission.
- Keep a copy for your records.
Multi Employer Worksite Details
Complete each field below with information specific to your multi employer worksite safety plan situation.
Multi-Employer Worksite Safety Plan Template
Full address including unit number if applicable.
Found on your assessment notice or tax bill.
The value the assessor assigned to your property.
What you believe the property would sell for, based on comparable sales.
Why you believe the assessed value is too high: comparable sales, condition issues, errors in property description.
Address, sale date, sale price, and how it compares to your property.
Address, sale date, sale price, and how it compares to your property.
Address, sale date, sale price, and how it compares to your property.
Contact Information
Your identification and contact details for this multi employer worksite safety plan document.
As it appears on your government-issued ID.
MM/DD/YYYY format.
Street, city, state, ZIP code.
Best number to reach you during business hours.
Optional but recommended for faster correspondence.
Signature
I certify that the information provided in this document is true and correct to the best of my knowledge.
Important Notes
- Do not submit this template with bracketed placeholder text still in place.
- Verify all information against your source documents before submitting.
- Keep the original completed document and at least two copies.
- Check whether the receiving office has specific formatting requirements.