BACKUP 2017 Exc in Safety Award App

Select Which Category (one per company) *

More Than 1 Million Annual Man-Hours in 2016 500,000 - 1 Million Annual Man Hours in 2016 250,000 - 500,000 Annual Man Hours in 2016 125,000 - 250,000 Annual Man Hours in 2016 Fewer Than 125,000 Annual Man Hours in 2016

Incident Summary Data

# of Deaths *

# Cases with days away from work *

# Cases with job transfer or restriction *

# Other recordable cases *

Total # days away from work *

Total # days of job transfer or restriction *

# of Injuries *

# Skin disorders *

# Respiratory conditions *

# of Poisonings *

# Cases of hearing loss *

# of All other illnesses *

Number of years company has had an Injury and Illness Prevention Program (IIPP) *

How many foremen, supervisors and managers received OSHA's 10 hr training? *

How many foremen, supervisors and managers received OSHA's competent person training? *

How many EMPLOYEES have received OSHA's 10 hour training? *

Name, phone, email of person officially responsible for safety & health in company *

How many foremen, supervisors and managers received OSHA's 30 hour training? *

How many employees work for your company? *

How many employees have received OSHA's 30 hour training? *

What methods are used to familiarize employees with the safety program? Check all that apply. *

What makes your safety program effective? Please type a brief statement in the box below that addresses:
A) The full involvement of employees, supervisors and management
B) Does it provide opportunities to identify specific workplace hazards to which employees are exposed?
C) Is effective training provided to all employees?

SAFETY AWARD APPLICATION

Incident Summary Data