Farm Safety Consultation Request Form
* Required
Name
*
Your answer
Farm Type
Select all that apply.
Crops (grains, oilseeds, potatoes)
Hog or Poultry
Horticulture (not including potato production)
Livestock (cattle, bison, dairy)
Beekeeping
Other:
Do you have WCB coverage for your farm?
*
Choose
Yes
No
Mailing Address
*
Your answer
Phone Number
*
Your answer
Email Address
*
Your answer
How did you hear about the Farm Safety Consultant service?
*
Your answer
Best time to contact you?
Your answer
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