Injury Prevention and Control Program
Order Form


If you have questions call 800.472.2286, select option 1.

Enter the quantity wanted for each item and the information requested below and press the "Submit" button at the bottom of the page.

Please limit quantities to 250 per item and allow 2 to 4 weeks for delivery.


Baby Safe Haven Materials            
Safe Haven Law Flyer for Approved Locations  Safe Haven Law Flyer   Hospital Checklist  Safe Haven Hospital Checklist    Approved Location Checklist  Safe Haven Approved Location List 
Medical History Form  Baby Safe Haven Medical History    Approved Location Door/Window Poster  Baby Safe Haven Approved Location Sign    Baby Safe  Haven Brochure   Baby Safe Haven Brochure 
Helmet Fit Checklist  Helmet Fit Test     Bike Safety Tips Bike Safety Tips    Pedestrian Safety Tips      Pedestrian Safety Tips 
Gun Safety Flyer  Gun Safety Flyer    A Parent Guide to Home Safety A Parents Guide To Home Safety    Home Safety Checklist      Home Safety Checklist 
Playground Safety Tips  Playground Safety Tips    Falls Prevention Tips for Kids Falls Prevention Tips for Kids       Poison Help Brochure    

What You Can Do to Prevent Falls
  Check for Safety    
Educational Items              
Poison Help Magnets (packs of 50)     Poison Help Stickers (packs of 100)    




Business/Health Agency Name:    

Mailing Address:  (Need Physical Address for UPS)   

City:      State:   Zip:        

Phone Number:    


Date Needed:    


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If you experience trouble submitting the form online, you can call your order in to the North Dakota Division of Injury & Violence Prevention at 800.472.2286 or 701.328.4536.