Lic7 Safety Form PDF Details

Are you looking for a reliable and safe way to keep track of your employees’ health and safety? The Lic7 Safety Form is the perfect solution to ensure that your workplace is up to OSHA standards. This comprehensive form helps employers keep records on any safety incidents, hazards, or other compliance issues that may arise in their businesses. Not only does it provide valuable insight into what’s actually happening on-site from an employee perspective, but also serves as a great preventative tool for future mishaps. Read on to learn more about why this form is essential for every business!

QuestionAnswer
Form NameLic7 Safety Form
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namessafety form application, lic7 2 online, form safety online, safety form printable

Form Preview Example

LIC7: Safety Registration Form

Application must be typed.

Must Apply In Person At : New York City Department of Buildings Licensing Unit

280Broadway, 6th Floor New York, NY 10007

1

Application Type

 

 

 

 

 

 

 

2

Safety Registration Number (existing tracking number)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Original

 

Renewal

 

Change/ Reissue

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

3

Safety Registration Endorsement Type Select all that apply

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Construction

 

 

 

 

Demolition

 

 

 

 

 

Concrete

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

4

Type of Business

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Individual / Sole Proprietor

 

 

 

Corporation

 

 

 

 

 

Partnership

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

5

Business Information Required for all applications. Business fax and mobile telephone are optional. Email is required.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Legal Name of Business

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Business’s Trade or Doing-Business-As (DBA) Name*

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Business Address

 

 

 

 

 

 

 

 

 

Business Telephone

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

City

 

 

 

State

Zip

 

 

 

Business Fax

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

E-Mail

 

 

 

 

EIN

 

 

 

 

 

 

6Primary Business Contact Home address required if applicant is an individual /sole proprietor. Contact must be director, officer or principal.

Last Name

 

First Name

Middle Initial

 

 

 

 

Social Security No

 

 

Date of Birth (m/d/y)

 

 

 

 

Home Address

 

 

Home Telephone

 

 

 

 

City

State

Zip

Mobile Telephone

 

 

 

 

E-Mail

 

 

% Control

7Corporate Officers, Partners and Any Stakeholders (Include Stakeholders that own ten percent or more and primary applicant)

Last Name

First Name

Middle Initial

 

 

 

 

 

 

 

Social Security No

% Control

Title

 

 

 

 

 

 

 

Date of Birth (m/d/y)

 

Telephone

 

 

 

 

 

 

 

E-mail

 

Emergency Contact

Yes

No

 

 

 

 

 

Last Name

First Name

Middle Initial

 

 

 

 

 

 

 

Social Security No

% Control

Title

 

 

 

 

 

 

 

Date of Birth (m/d/y)

 

Telephone

 

 

 

 

 

 

 

E-mail

 

Emergency Contact

Yes

No

 

 

 

 

 

Last Name

First Name

Middle Initial

 

 

 

 

 

 

 

Social Security No

% Control

Title

 

 

 

 

 

 

 

Date of Birth (m/d/y)

 

Telephone

 

 

 

 

 

 

 

E-mail

 

Emergency Contact

Yes

No

 

 

 

 

 

Last Name

First Name

Middle Initial

 

 

 

 

 

 

 

Social Security No

% Control

Title

 

 

 

 

 

 

 

Date of Birth (m/d/y)

 

Telephone

 

 

 

 

 

 

 

E-mail

 

Emergency Contact

Yes

No

 

 

 

 

 

Last Name

First Name

Middle Initial

 

 

 

 

 

 

 

Social Security No

% Control

Title

 

 

 

 

 

 

 

Date of Birth (m/d/y)

 

Telephone

 

 

 

 

 

 

 

E-mail

Emergency Contact

Yes

No

9/09

LIC7

 

 

PAGE 2

 

 

 

 

8

Business Affiliation Information

 

 

 

 

 

 

 

 

Yes

 

No

Is any person named on this application an employee, participant in the management of, or own a controlling interest for any other

 

 

 

 

 

 

 

 

entity which files for permits with the Department? If “YES” you MUST complete the section below.

 

 

 

 

 

 

 

Yes

 

No

Any current or former association with another General Contracting company in the last 5 years not mentioned on this application?

 

 

 

 

 

 

 

 

If “YES” you MUST complete the section below.

 

 

Yes

 

No

Has any person named on this application ever been employed by DOB or another City agency? If “YES” provide details in

 

 

 

 

 

 

 

 

Section 9.

 

 

 

 

 

 

Name of Individual

 

 

% Control

 

 

 

 

Legal Name of Business

 

 

Title

 

 

 

Business’s Trade or Doing-Business-As (DBA) Name*

 

 

 

 

 

 

Business Address

 

 

Business Telephone

 

 

 

 

City

State

Zip

EIN

 

 

 

 

Name of Individual

 

 

% Control

 

 

 

 

Legal Name of Business

 

 

Title

 

 

 

Business’s Trade or Doing-Business-As (DBA) Name*

 

 

 

 

 

 

Business Address

 

 

Business Telephone

 

 

 

 

City

State

Zip

EIN

 

 

 

 

Name of Individual

 

 

% Control

 

 

 

 

Legal Name of Business

 

 

Title

 

 

 

Business’s Trade or Doing-Business-As (DBA) Name*

 

 

 

 

 

 

Business Address

 

 

Business Telephone

 

 

 

 

City

State

Zip

EIN

9 Comments

10 Applicant Statements and Signatures

I have read and I understand all the items contained in this document. I state that the above information is correct and complete to the best of my knowledge. I understand it is unlawful to make a false statement to the Department; or to give to a city employee, or for a city employee to accept, any benefit, monetary or otherwise, either as a gratuity for properly performing the job or in exchange for special consideration. Such actions are punishable by imprisonment, fine and/or loss of registration.

Name (print)

Signature

Date

Notarization

State of New York, County of:

Sworn to or affirmed under penalty of perjury

Day of

20

Notary Signature

Notary Seal

Internal Use Only

Date received:

 

Fee Paid:

$

Reviewed by:

 

 

 

 

 

 

Comments:

 

 

 

Status:

¨ Satisfactory

¨ Unsatisfactory

9/09

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A way to fill out safety registration number step 1

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