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3M OH&ESD Construction Survey

Please complete this survey to receive your free Construction Safety Product Sample Pack from 3M. You must be a current AGC-Minnesota member and you must answer all questions to receive free safety packs. Javascript must be enabled on your browser to submit your entry.

*Required field
*First Name:
*Last Name:
*Title or job function
*Company Name:
*Address (to send samples):
*City:
*State:
*Zip:
*Telephone:
*Email Address:
*Confirm Your Email Address:
*What types of PPE are your employees wearing? (check all that apply):
Eyewear
Fall Protection
Gloves
Headgear/faceshield
Hearing Protection
High Visibility Safety Apparel
Jackets
Respirators
Welding Helmets
None
Other
*What safety related concerns are you dealing with on a day-to-day basis? (check all that apply):
Compliance with High Visibility safety standards (e.g., ANSI/ISEA 107-2004, 23 CFR Part 634 Worker Visibility, 2009 MUTCD)
Eye Injuries
Fall Protection
Fit Testing (if wearing respirators)
Head Protection
Hearing Conservation
Heat Stress
Lead
Respirator Program Administration (training, medical evaluation, fit testing)
Safety Training
Silica
Site Communication
Welding Fumes
None
Other
*Which description best describes your firm?
General Contractor
Heavy & Civil Contractor (sewers, tunnels, bridges, roadways)
Specialty (carpenters, painters, electrical)
Other
*Are you actively pursuing contracts relative to the government Economic Stimulus Package?
We've bid contracts
We've bid and won contracts
We're not pursuing contracts
Other
*As a provider of safety products, how can 3M best suit your needs for information? (check all that apply):
Catalogs
Email
Sales Representative Visit
Technical Information
Training & Educational Information (for CEU, CM or COC points)
Website
Other

*Limit one sample pack per construction customer. Sample packs may only be awarded during time of promotion and accompanied with completed survey. Promotion begins on 11/9/09 and will run through 12/11/09, or while free samples last. 3M reserves the right to discontinue or terminate the promotion at any time. 3M also reserves the right to limit sample packs to qualified construction accounts only. Offer valid in the U.S. only. Please allow 6-8 weeks for delivery. A 3M sales representative may call you to ensure you received your sample pack, and to help you with any questions you may have about 3M safety products.

Subscribe now to receive the following from 3M (check all that apply):
Periodic 3M safety related communications including product information and promotions, regulatory updates, and training opportunities.
JobHealth Highlights Newsletter contains technical information for occupational health and safety professionals. Issued every 6-8 weeks. See examples.

We will only use this information as described by our privacy policy.