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Safety Services Invoice Form

Safety Manager*
Company*
Contact Name
First Last
Type of Work*
Contract Work
Quarter of Contract Work
Year of Contract Work
Number of Visits Per Month
Training
Select Training
- OSHA 10 Hour
- OSHA 30 Hour
- Arc Flash Safety
- Confined Space Entry Awareness
- Confined Space Entry Certification
- Equipment Evaluations
- First Aid / CPR / AED / Bloodborne Pathogen
- Forklift Certification Straight Mast (Class IV & V)
- Forklift Certification Rough Terrain (Class VIII)
- In-house Training
- Job Site Services
- MEWP / Scissors Lift / Aerial Lift Safety
- Rigging & Signal Person
- Silica Sampling
- Trenching & Excavation
- Other
Training Date
MM slash DD slash YYYY
Open Class Training Quantity
Price: $65.00
$65 per hour. Enter number of hours for Quantity.
In-house Training Quantity
Price: $200.00
$200 per hour. Enter number of hours for Quantity.
Job Site Services Quantity
Price: $200.00
$200 per hour. Enter number of hours for Quantity.
Equipment Evaluations Quantity
Price: $200.00
$200 per hour. Enter number of hours for Quantity.
OSHA 10 Hour
- 20 People or Less: $1,400.00
- Over 20 People: $1,500.00
- Over 30 People: $2,200.00
OSHA 30 Hour Quantity
Price: $4,500.00
$4,500/class
Arc Flash Safety Quantity
Price: $200.00
$200 per hour. Enter number of hours for Quantity.
Confined Space Entry Awareness Quantity
Price: $200.00
$200 per hour. Enter number of hours for Quantity.
Confined Space Entry Certification Quantity
Price: $200.00
$200 per hour. Enter number of hours for Quantity.
Number of Training Sessions
First Aid – Session 1
First Aid / CPR / AED / Bloodborne Pathogen – Session 1
- 10 or Fewer People: $700.00
- More than 10 People: $800.00
First Aid – Session 1 Training Date
MM slash DD slash YYYY
First Aid – Session 1 Training Time

: Hours

Minutes

AM/PM
First Aid – Session 2
First Aid / CPR / AED / Bloodborne Pathogen – Session 2
- 10 or Fewer People: $700.00
- More than 10 People: $800.00
First Aid – Session 2 Training Date
MM slash DD slash YYYY
First Aid – Session 2 Training Time

: Hours

Minutes

AM/PM
First Aid – Session 3
First Aid / CPR / AED / Bloodborne Pathogen – Session 3
- 10 or Fewer People: $700.00
- More than 10 People: $800.00
First Aid – Session 3 Training Date
MM slash DD slash YYYY
First Aid – Session 3 Training Time

: Hours

Minutes

AM/PM
First Aid – Session 4
First Aid / CPR / AED / Bloodborne Pathogen – Session 4
- 10 or Fewer People: $700.00
- More than 10 People: $800.00
First Aid – Session 4 Training Date
MM slash DD slash YYYY
First Aid – Session 4 Training Time

: Hours

Minutes

AM/PM
Forklift Certification Straight Mast (Class IV & V) Quantity
Price: $200.00
$200 per hour. Enter number of hours for Quantity.
Forklift Certification Rough Terrain (Class VIII) Quantity
Price: $200.00
$200 per hour. Enter number of hours for Quantity.
MEWP / Scissors Lift / Aerial Lift Safety Quantity
Price: $200.00
$200 per hour. Enter number of hours for Quantity.
Rigging & Signal Person Quantity
Price: $200.00
$200 per hour. Enter number of hours for Quantity.
Silica Sampling
- Half Day: $800.00
- Full Day: $1,600.00
Trenching & Excavating Quantity
Price: $200.00
$200 per hour. Enter number of hours for Quantity.
Job Site Services Quantity
Price: $200.00
$200 per hour. Enter number of hours for Quantity.
Other: Training Description
Other: Fee
Materials Cost
Number of Attendees – OSHA 10 Quantity
Price: $22.00
Number of Attendees – OSHA 30 Quantity
Price: $35.00
OSHA 30 Book Fee
Number of Books for OSHA 30
Total for OSHA 30 Books
Price: $0.00
Number of Attendees – Arc Flash Quantity
Price: $15.00
Number of Attendees – Confined Space Awareness Quantity
Price: $15.00
Number of Attendees – Confined Space Certification Quantity
Price: $25.00
Number of Attendees – First Aid / CPR / AED Quantity
Price: $17.00
Number of Attendees – Forklift Certification Straight Mast (Class IV & V) Quantity
Price: $25.00
Number of Attendees – Forklift Certification Rought Terraine (Class VII) Quantity
Price: $25.00
Number of Attendees – MEWP / Scissors Lift / Aerial Lift Safety Quantity
Price: $25.00
Number of Attendees – Rigging & Signal Person Quantity
Price: $35.00
Number of Attendees – Trenching & Excavation Quantity
Price: $25.00
Lab Fees
Additional Costs
Number of Miles
Per Mile
Mileage Due
Price: $0.00
Lodging
Truck Rental
Other
Comments
Please explain costs associated with “Other” from above or any other notes for this invoice.
Commission Amount
Total to Invoice
$0.00

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