Farm Safety Consultation Request Form

* Required

Name *

This is a required question

Farm Type

Select all that apply.

Crops (grains, oilseeds, potatoes)
Hog or Poultry
Horticulture (not including potato production)
Livestock (cattle, bison, dairy)
Beekeeping
Other:

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Do you have WCB coverage for your farm? *

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Mailing Address *

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Phone Number *

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Email Address *

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How did you hear about the Farm Safety Consultant service?

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Best time to contact you?

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