Worksite Fact Sheet

WORKSITE fact sheet

The use of the following form is intended to help Arbor Associates provide the best customer service possible. Please complete accurately, and note that information can be updated in the future as needed. A separate 'Worksite Fact Sheet' must be submitted and approved for each location at which you'd like to use Arbor Associates' services. The 'Worksite Name' that you list will be used for invoices, requesting staff, and conveying information to Arbor staff, in conjunction with the 'Organization/Agency Name'.

Please contact us at 888-272-6767 x 403 with questions. Thank you!

General Information

* Indicates required field

ORGANIZATION / AGENCY NAME *

WORKSITE NAME *

WORKSITE PHONE *

WEBSITE *

WORKSITE ADDRESS *

Line 1

Line 2

City

State

Zip Code

Country

FAX *

pRIMARY CONTACT INFORMATION

PRIMARY CONTACT FOR WORKSITE *

First

Last

PRIMARY CONTACT POSITION TITLE *

PRIMARY CONTACT EMAIL *

PRIMARY CONTACT PHONE *

AFTER HOURS/URGENT CONTACT INFORMATION

AFTER HOURS CONTACT (OTHER THAN PRIMARY CONTACT) *

First

Last

AFTER HOURS CONTACT POSITION TITLE *

AFTER HOURS CONTACT EMAIL *

AFTER HOURS CONTACT PHONE *

tIME SHEET APPROVER

TIME SHEET APPROVER (IF OTHER THAN PRIMARY CONTACT) *

First

Last

TIME SHEET APPROVER POSITION TITLE *

TIME SHEET APPROVER EMAIL *

TIME SHEET APPROVER PHONE *

Accounts payable contact (for invoices)

ACCOUNTS PAYABLE CONTACT *

First

Last

ACCOUNTS PAYABLE CONTACT POSITION TITLE *

ACCOUNTS PAYABLE CONTACT EMAIL *

ACCOUNTS PAYABLE CONTACT PHONE *

WORKSITE DETAILS

WORKSITE TYPE(S) *

CONSUMER CHALLENGES/POPULATIONS *

CONSUMER AGE RANGE *

STAFF TO CONSUMER RATIO(S) *

STAFFING REQUIREMENTS + INFORMATION

POSITION TITLE *

JOB DESCRIPTION AND EXPECTATIONS FOR ARBOR STAFF *

IS THERE AN ORIENTATION MANUAL ON SITE FOR OUR STAFF? *

Yes No N/A

GENERAL EMERGENCY PROCEDURES *

DRESS CODE FOR ARBOR STAFF *

SPECIFIC SKILLS REQUIRED BY ARBOR STAFF (ALL HAVE FIRST AID / CPR) *

SPECIFIC CERTIFICATIONS REQUIRED BY ARBOR STAFF *

WILL ARBOR STAFF BE REQUIRED TO COMPLETE WORKSITE-SPECIFIC CERTIFICATION OR TRAINING *

Yes No

GENDER REQUIREMENTS FOR ARBOR PLACEMENT *

None Yes - place female staff only Yes - place male staff only Depends on shift /current population

lOCATION DETAILS

IS GPS ACCURATE FOR DRIVING DIRECTIONS? *

Yes No

IS ON-SITE PARKING AVAILABLE? *

Yes No

LIST ANY USEFUL LANDMARKS OR DETAILS ABOUT THE LOCATION *

IS THE LOCATION ACCESSIBLE BY PUBLIC TRANSPORTATION? *

Yes No

IF YES, PUBLIC TRANSPORTATION DETAILS *

THIS FORM COMPLETED BY:

NAME *

First

Last

POSITION TITLE *

DATE *

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