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Safety Summary Form Online Process

Welcome to the State of New Hampshire's Safety Summary Form online filing application. We are in the process of redesigning all our online applications. The online application for completing the Safety Summary Form is not yet available. In the interim we request you follow the process below. Thank you for your patience.

Notice: Effective January 1, 2013 this form is required for all employers:

  • With 15 or more employees at any time during the calendar year and
  • Have never filed before or have not filed this form since 2010.

There are presently three options for filing the Safety Summary Form with the Department of Labor.

Option One: Download the Adobe PDF version of the form, print it, complete it manually and either fax or mail it in. See the fax and mailing address below.

Option Two: Download the Microsoft Word version of the form, complete it electronically and email it or print it out and fax or mail it to Department of Labor. You must have Microsoft Word on your personal computer to use this option.

Option Three: Telephone or email the Inspection Division at Department of Labor to have a safety Summary form mailed to you to complete and return.

Download Form and Instructions:

Safety Summary Form as PDF Adobe Acrobat Reader Symbol
Safety Summary Form as Word Document Microsoft Word Symbol
Safety Summary Form Supplemental Instructions Adobe Acrobat Reader Symbol

Contact Information:

Mailing Address:

Safety and Training
New Hampshire Department of Labor
PO Box 2076
Concord, NH 03302-2076

Telephone Number: (603) 271-6850 or (603) 271-6297
Fax Number: (603) 271-2668
Email Address: SafetyDiv@dol.nh.gov

Adobe Acrobat Reader Symbol Adobe Acrobat Reader format. You can download a free reader from Adobe.

Microsoft Word Symbol Microsoft Word format. You can download a free reader from Microsoft.


New Hampshire Department of Labor  |  
95 Pleasant Street  |  Concord, NH 03301
Telephone: 603-271-3176  |  
Hours of Operation: 8am - 4:30pm M-F