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Safety Champion

Dear Crothall Manager, please take a few minutes of your time to complete the following questionnaire by Wednesday, September 3, 2025.

Secured
1

House Code Number

2

Director's Name

3

Do you have a manager who also serves as Safety Champion for the account?

Select one or more answers
4

What is the name of your account’s Safety Champion?

Please enter N/A if you do not have one.