Crucible Safety Media - Product Registration

Product Activation Form
To register your product, fill out the Crucible Safety Media registration form and submit below. If you register, you may qualify for any future product upgrades and our support services.

1. How did you first learn about this product?


Other (specify):

2. What best describes your profession?


Other (specify):

3. What best describes your organization?


Other (specify):

4. How do you plan to use this product?

5. Have you trained with multimedia or computer-based training before using this product?

6. When you provide safety training, which of the following best applies?

7. What type of multimedia equipment do you own?

Laptop computer

LCD projector

Desktop computer

I rent some or all of these as needed

Other (specify):

8. How many people do you train in OSHA 10/30 Hour courses each year?

9. What is your affiliation with the safety profession?

Member of ASSE, NFPA, NSC, etc.

ASP, CSP, CIH

Practical field experience only

College degree

No affilation with the safety profession

10. How would you describe your experience using this product?

Easy to use, smooth operation

Troublesome, numerous glithces

Good graphics, pictures, and sounds

Comprehensive

Too limited in content and courses

Meets or exceeds your expectations

My computer runs slowly when using this program

* Registration/Serial Number:
* Name:
* Email Address:
Organization:
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City:
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Telephone Number:
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If you have any other comments, use the space below:

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CUSTOMER TESTIMONIAL

"Our orientations typically included an oral presentation given by one of our safety representatives or foremen. This gave us very little control over consistency, however, and left the training open to omissions. Crucible produced a video that addresses all the safety issues that crop up on a job, using our personnel at our sites. The process itself was a great experience and everyone loves the video, from management to new employees. It really reinforces how important safety is to Southland as a company."

Reyanne Contreras,
Director of Safety, Southland Industries