Workplace Safety and Health Visit Request

Since this service is voluntary, employers must request a consultative visit.

For Employers to Request a free workplace safety and/or health consultative visit from the Massachusetts Department of Labor Standards, On-Site Consultation Program please submit the form below or send us the information in one of the following ways:

Fax: 617-244-2705
Telephone: 617-969-7177

Massachusetts Department of Labor Standards
On-Site Consultation Program
1001 Watertown Street, 2nd Floor
West Newton, MA 02465

Masscon@state.ma.us

Employers may also complete the form below and print it, or may submit the form electronically by E-Mail. ( If your system does not transfer the information to an E-Mail message automatically you will have to do so manually or use one of the other methods.) Be Sure to Answer ALL required questions marked with (*).

Did You Read and Understand The Instructions and
Are you an employer?: *
Check if your answer is "yes"

DATE (mm/dd/yyyy):*

Establishment Name:*

Site Address:*

Mailing Address:*

Type of Business:*

Contact Name:*

Contact Title:*

Phone Number:*

Fax Number:*

Sic_Code:

Number of Employees:*

Requesting:
Safety Visit
Health Visit
Both