COR Registration Registration Date (MM/DD/YYY) WorkSafeBC Account Number/s Legal Name of Company (registered with WorkSafeBC) Operating Name Number of FTEs (FTE: full-time employees) Number of Operating Locations Classification Unit Classification Unit 2 (if applicable) Classification Unit 3 (if applicable) Classification Unit 4 (if applicable) First & Last Name of Company Contact Title of Company Contact Company Address Email Company Phone Number Company Fax Number I have read and agreed to the Terms of Participation and wish to participate in AgSafe's Certificate of Recognition Program I commit that our company will endeavour to develop our OHS Program to the AgSafe COR Standard, to achieve Certification