CSA International - Product Areas - Transportation and Carrier Safety Management Systems

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CSMS On-line Order Form

File No.:

Client:

Sites:

Scope:

Contact Name:

Title:

Invoice To (if different from Client):

Purchase Order:

To facilitate your application to CSMS, please answer the following questions in detail.

Please complete separate forms for each facility ("Site") that will be part of your application.

Organization Profile

Name:
Address:
City:
State/Prov:
Postal/Zip:
Contact name:
Phone:
Position:
Fax:
Email:

Please indicate the primary goods transported by your organization and the manner in which they are transported, e.g. "General freight," "Flammable liquids," etc. List all service lines offered by your organization.

Cargo Type 1:
Cargo Type 2:
Cargo Type 3:
Cargo Type 4:
Cargo Type 5:
Cargo Type 6:
Cargo Type 7:

Site Information

# Vehicles operating out of this site:
Power units Trailers

Employees working from this site:
Drivers Total

Does this site include maintenance facilities for the vehicles operating from it?
Yes No

Does this site have storage and/or loading facilities for cargo?
Yes No

Do vehicles at this site haul any cargo classified as "Dangerous goods?"
Yes No

Do vehicles at this site haul oversize/overweight goods?
Yes No

Please indicate any special safety requirements, rules, or issues our auditors should be aware of when visiting this site:

Do vehicles operating from this site operate in other provinces?
Yes No

If yes, please name the provinces in which they operate:

Do vehicles operating from this site operate in the United States?
Yes No

Please name your insurance company(s) for vehicle and cargo insurance, with contact information and insurance policy number(s).

If you do not submit your Safety Manual with this package, you will need to do so before the qualification process can begin.

If it is not included, when will it be ready for review?

Does this Safety Manual refer only to this site or is it used for other sites as well?

What is the approximate date you would like to have your qualification audit?

Are you interested in having CSA perform a pre-registration audit?
Yes No

Are you using the services of a consultant to implement CSMS?
Yes No

If yes, which consultant?

How did you hear about CSMS and/or Transportation Services?
Trade advertisement (please indicate which one)
Conference
Consultant referral
Referral from another carrier
CSA publications

Learn more today:

Transportation Services
CSMS Standard/ Transportation Standards
CSMS Qualification Program
CSMS On-line Order Form
On-line Store
Contact Transportation Services