Free F417-206-000 video library reservation form - Washington

Department of Labor & Industries Safety & Health Video Library PO Box 44607, Olympia, WA 98504-4607 Phone: 1-800-574-9881 FAX (360) 902-5675

RESERVATION FORM
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Safety & Health Video Library

The earlier you request, the more likely you are to get your reservations. Plan early for seasonal topics. You can book up to 6 months in advance. Processing your video request requires advance notice by 3:00 PM at least 8 calendar days prior to your show date.
Borrower ID Number Phone Number
New number ?

Name Business Name Street Address, City & Zipcode (must be Washington state address) New address?

Fax Number

Format Preference: VHS only DVD only Both, my preference is VHS DVD Not every title is available in DVD. Before ordering, search online for DVD titles, at http://videos.lni.wa.gov Video ID Number List desired show date and alternate date
If not available on desired dates,

then as soon as I can get it.
Yes Yes Yes Yes Yes No No No No No

Any other info, e.g. Is it OK to switch videos requested, just so 1 video per date is reserved? Yes No

(Library Use Only)

Confirmed Show Date

V V V V V List alternate video choices below. V V V V LIBRARY RESPONSE CODES:

Yes Yes Yes Yes

No No No No

N/A F/S W/D N/B -

Not available for dates listed Limited to 5 videos per show date Withdrawn from collection Can only book six months in advance

F417-206-000 safety & health video library reservation form 12-2007