OSHALogs Setup Form

A. Company Information

1. Company Name

How would you like your Company's Name listed in the OSHAlogs system?

4. Company's Main Phone Number

5. Type of Employer

(Choose One Below)

Private
Government

Number of Employees

1-50
over 50

2. Company's Headquarters Address

Main Headquarters Address - Please Include Street, City, State, and Zip

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

3. Company's Mailing Address

If same as above, leave blank.

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

7. List Company's Locations

Each location will be considered an "establishment" and require its own OSHA 300 and OSHA 300A. List each locations SIC Code and NAICS Code. If you do not know these codes you can always leave blank and add them later.

Location Name	Location(s) Full Address	SIC Code	NAICS Code

B. User Information

8. Who Will Be the Administrator for your Company?

This will be your Company's primary user and will have full access to OSHAlogs. This would typically be an HR person or Safety Manager.

First Name	Last Name	Title	Email Address

9. Are There Any Additional/Basic Users you would like added?

These users will have access to the system, but their access will be more limited than that of an Administrator User

First Name	Last Name	Title	Email Address

C. Work Comp Policy Information

If UNICO or UNITEL currently manages your WorkComp policy, you do not need to fill out the below fields.

12. Work Comp Carrier Name

13. Work Comp Policy Start Date and End Date

Start Date:	End Date:

Once you have completed the above form, click submit below. A UNICO Group Representative will contact you to complete your enrollment within 2 business days.