Workplace Injury Prevention Booking Form

Please fill out the form below to request a booking for Workplace Injury Prevention Program, and I will get back to you shortly.

Name of Business/Organization

Number of Participants

What are common injuries at your workplace?

What are common health concerns at your workplace?

Please describe a regular workday at your workplace.

Are ergonomic modifications to workspaces being currently used?

On a scale of 0 to 10, please rate the average stress levels at your workplace.

"0" corresponds to total relaxation and "10" corresponds to complete and utter panic)

What supports are currently in place for the health and wellness of your workers/participants?

What are the major challenges or barriers your workers/participants face to supporting health and wellness?

Do you feel that the current state of health, wellness, and potential injuries are impacting the effective function of the workplace?

What are the regular working hours for your business/organization?

At what time could I visit your workplace to get a clear observation of the work environment in action?

What time slot would best suit your workplace for this session?

9am to 12pm

12pm to 4pm

4pm to 8pm

Any other major concerns or areas I may be able to offer support?