Stand-Down Event Submission Form

Join the

National Safety
Stand-Down

To Prevent Falls in Construction

Region	States / Territories	Name	Email	Phone
1	CT, MA, ME, NH, RI, VT	Joseph Green	Green.Joseph@dol.gov	978-837-4470
1	CT, MA, ME, NH, RI, VT	Peter Barletta	Barletta.Peter@dol.gov	781-664-2904
2	NJ, NY, PR, VI	Brian Crain	Crain.Brian@dol.gov	856-596-5229
3	DC, DE, MD, PA, VA, WV	Isabel DeOliveira	DeOliveira.Isabel@dol.gov	215-861-4931
4	AL, FL, GA, KY, MS, NC, SC, TN	Kaylene Sherrod-Moore	SherrodMoore.Kaylene@dol.gov	678-237-0439
4	AL, FL, GA, KY, MS, NC, SC, TN	Tom Bosley	Bosley.Tom@dol.gov	678-237-0443
5	IL, IN, MI, MN, OH, WI	Richard Langenderfer	Langenderfer.Richard@dol.gov	312-886-6293
6	AR, LA, NM, OK, TX	Meghan Christie	Christie.Meghan@dol.gov	972-850-4196
7	IA, KS, MO, NE	Brian Wood	Wood.Brian.L@dol.gov	816-502-9034
7	IA, KS, MO, NE	Jo Beth Cholmondeley	Cholmondeley.JoBeth@dol.gov	816-502-9009
8	CO, MT, ND, SD, UT, WY	James Messer	Messer.James@dol.gov	406-780-0315
9	AS, AZ, CA, GU, HI, MP, NV	Todd Brady	Brady.Todd@dol.gov	702-281-6251
10	AK, ID, OR, WA	Hana Patterson	Patterson.Hana.M@dol.gov	206-757-6697
OTE	OSHA Education Centers	John Olaechea	Olaechea.John@dol.gov	847-759-7785

To be posted on the Stand-Down webpage, this event must be free (no cost to attendees) and open to the public (to include the Press). This completed form will be submitted to your Regional Stand-Down Coordinator.

The fields indicated with an asterisk (*) are required to complete your submission.

State: * Required

City:

Date:

Event Start Time:

Event End Time:

Location Details:

Description:

Event Contact Name: * Required

Event Contact Phone: * Required

Event Contact Email: * Required

Checking this box confirms that the event is free and open to the public.