2018 Excellence in Safety Award Application
 
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  Deadline December 14, 2018  

 
1.
Award Winners will be recognized at the 2019 Walter F. Pruter Project of the Year Awards *
 

 

 

 

 

 

 

 
 
 
 
2.
Please select one category per company*
 
 
 
 
 
 
 
3.
Incident Summary Data. If none, type "0" in box*
 

 

 

 

 
 
 
 
4.
Injury or Illness Data. If none, type "0" in box*
 

 

 

 

 
 
 
 
5.
Experience Modifier Information. *
Input the workers' compensation Experience Modification Rate (EMR) from the insurance company
 

 

 

 
 
 
 
6.
Recordable Incident Rate If none, type "0" in box*
 

 

 

 
 
 
 
7.
Operations and Best Practices *
If none, type "0" in the box
 

 

 

 

 

 

 

 

 
 
 
 
8.
What methods are used to familiarize employees with the safety program*
Please select all that apply
 
 
 
 
 
 
 
 
9.

 
 
 
 
10.
What makes your safety program effective*
Please type a brief statement in the box below that addresses:
 
 
 
 
 
 
11.

 
 
 
 
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