Floor Warden Questionnaire - ICE Safety Solutions

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Floor Warden Questionnaire

Thank you for taking the time to enhance your internal operations. The following questionnaire is designed to assist ICE Safety Solutions in collecting information to build your Floor Warden training.

Step 1 of 4

25%

General Company Information
Company Name*
Address of Building*
Street Address Address Line 2 City State ZIP Code
Primary Contact
Name*
First Last
Email*
Direct Phone*
Mobile Phone

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Is the building/facility leased or owned?*
- Leased
- Owned
Is the building/facility free standing?*
- Yes
- No
List Your Occupied Floors*
e.g. 4, 7, 8, 9.
Select All Life Safety Features of Your Building*
- Select All
- Alarm - Audible
- Alarm - Visual Strobe
- Automated Closing Doors (Fire Doors)
- Emergency Stairwells (Fire Rated)
- Exterior Breakout Windows (for Fire Department)
- Fire Extinguishers
- Fire Sprinklers
- Illuminated Exit Signs
What is the procedure to call Emergency Responders for a Medical Emergency at the worksite?*
Please note any special steps needed to dial out from company telephones.
Evacuation
Please Upload Image(s) of Assembly Areas*
Assembly areas are the locations where you'd gather after evacuating the building. We recommend taking a screenshot from google maps and making notes on the image with your 'paint' program. You can also upload street level photos that help, such as a photo of a particular light post/street sign.
Drop files here or

Accepted file types: jpg, gif, pdf, png, Max. file size: 512 MB.
Upload Floor Plans*
Please ensure there is an image available for each floor your company occupies in the building.
Drop files here or

Max. file size: 512 MB.

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Please list hazardous chemicals or substances.
Do the chemicals have Safety Data Sheets (SDS) easily accessible to employees?
- Yes
- No
Please describe the location of the Safety Data Sheets.
What method can Employees retain the SDS on their Smart Phones. What Smart Phone Apps are you using?

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Safety Supplies
Check all types of safety supplies/equipment that are available.*
- First Aid Kits
- AEDs
- Disaster Supplies
- Eyewash Stations
- Personal Protective Equipment
- Fire Extinguishers
- Other
Other Safety Equipment
Please select all types of disaster supplies available.
List locations of disaster supplies.
Example: Copy Room, 2nd Floor
Please attach a copy of your most recent Injury and Illness Prevention Plan (IIPP) or Emergency Action Plan (EAP).
Accepted file types: pdf, doc, docx, Max. file size: 512 MB.
That's it! We'll get started on this. In the meantime, do you need someone to contact you about any of these?
- CPR/First Aid/AED Training
- ERT/Floor Warden Training
- Bomb Threat, Fire Extinguisher, or Other Safety Training
- Online OSHA Training
- Safety Supplies
- First Aid Kit/AED Inspections and Maintenance
- AED Program Management

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47703 Fremont Blvd.
Fremont, CA 94538

877-7GETICE 877-743-8423

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