Safety Coordinator Registration

For a summary of the Safety Coordinator Program , please refer to the attachment Safety Coordinator Pamphlet

Please fill out the information below.

If city employee, enter employee ID here to populate contact details

First Name*

Last Name*

Phone Number*

Email*

City of Phoenix Employee

Yes No

AVN Division

Company*

Airport Location*

Safety Coordinator duties Assignment (select 1 or more)

Company Point of Contact(POC)

Construction Safety Liaison

Committee Member

Training

Fire Rep

Safety Data Sheets (SDS)