Building Captain/Floor Manager Application Form – Environmental Health & Safety

Please fill out this form if you are interested in becoming a Building Captain or Floor Manager. Make sure your supervisor is aware that you are interested and willing to allow you to use a small amount of work time for trainings and duties associated with these positions.

Applying for:*
- Building Captain
- Floor Manager
Desired Floor

Which floor do you want to be the floor captain for?
Name*
First Last
Email*
Phone*
Office Location*
Job Title*
Building*
Department*
Related Experience
Do you have any previous training or positions related to safety, health or emergency management?
Personal Statement for Consideration
Please indicate why you are interested in becoming a Building Captain or Floor Manager
Supervisor’s Information
Employees must have supervisor approval to spend a small amount of their work time on this program. Please include your supervisor’s contact information below.
Supervisor's Name*
First Last
Supervisor's Email*
Supervisor's Phone*
Hidden
Does this location need a Building Captain or Floor Manager?
- No
- Yes
Hidden
Do we have supervisor approval?
- No
- Yes
Hidden
Has the individual been contacted?
- No
- Yes

Supervisor’s Information