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The purpose of this award is to acknowledge and reward those companies who have implemented pro-active programs and goals to create safe and healthy work environments to better our industry.
The identity of each company's submission will be confidential and withheld from the award judges. For privacy purposes, upon submission the SEAA office will assign the company's application a unique number. Any data furnished in this application will not be made public at any time and will only be used as a metric to base award recognition.
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Indicates required field
Company Name
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Company Address
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Line 1
Line 2
City
State
Zip Code
Country
Contact Name
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First
Last
Phone Number
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1. List your company's Interstate Experience Modification Rate for the three most recent years. If EMR rate exceeds 1.00 in any of the three years (or is increasing), a letter of explanation, including proactive planning, will be required.
Year
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EMR
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Year
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EMR
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Year
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EMR
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Upload letter of explanation (if applicable)
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Max file size: 20MB
2. Please use your 2020 OSHA 300A Summary Log to complete the following information:
(please submit your summary logs for documentation)*
A. Total number of recordables on OSHA 300A form:
Untitled
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Recordable Incident Rate
Untitled
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B. Total number of Lost Time on OSHA 300A form
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Lost Time Incident Rate
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C. Total number of DART on OSHA 300A form
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DART
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D. Total number of OTHER on OSHA 300A form
Untitled
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E. Employee hours worked last year
Untitled
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F. Average number of employees
Untitled
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G. Were there any fatalities?
Choose One
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Yes
No
If yes, how many fatalities?
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* Please submit copies of
OSHA 300A Summary Log for 2018, 2019 & 2020. Points will be deducted if not submitted
Upload File
*
Max file size: 20MB
Upload File
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Max file size: 20MB
Upload File
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Max file size: 20MB
3. Have You had any OSHA citations for the calendar year 2020?
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If so, what severity?
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Serious
Da Minimus
Failure to Abate
Repeat
Other
4. Do you have a written safety program, including a Hazard Communication Policy?
Please select yes or no.
If yes, enclose a copy of Table of Contents. Points will be deducted if not submitted.
Select One
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Yes
No
Upload File
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Max file size: 20MB
5. When was the last revision of your Health & Safety Policy?
Date of last revision
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6. Are the costs of individual accidents kept? Please answer yes or no.
Select One
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Yes
No
If yes, how are they reported?
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7. Do you have an orientation program for new hires? Please answer yes or no.
Select One
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Yes
No
If yes, describe the program briefly:
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8.
Do you submit site specific safety plans
? Please answer yes or no.
Select One
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Yes
No
If yes, how often?
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*Please provide a SSSP cover page & table of contents for a project in 2020
.
Points will be deducted if not submitted
Upload File
*
Max file size: 20MB
Upload File
*
Max file size: 20MB
9. Do you have a disciplinary program?
Select One
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Yes
No
Please provide a safety related “write up” for the year 2020. Points will be deducted if not submitted.
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Max file size: 20MB
10. Do you conduct frequent project safety inspections? Please answer yes or no.
Select One
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Yes
No
If yes, how often?
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11. Do you have a 100% Fall Protection 6’ and above policy for all projects? Please answer yes or no.
Select One
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Yes
No
12. Do you have a daily Stretch & Flex program?
Please answer yes or no.
Select One
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Yes
No
13. Do you require supervisors to perform daily JSA Job Safety Analysis or Pre-Task meetings? Please answer yes or no.
Select One
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Yes
No
Please provide a site pre task or JSA from 2020. Points will be deducted if not submitted.
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Max file size: 20MB
14. Do you have a Behavioral Based Safety Program?
Select One
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Yes
No
If yes, how are they reported AND what do you do with the information?
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15. Do you provide the following training for all Ironworkers?
Choose Any
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Fall Protection
GHS Hazcom
Silica
OSHA 10
OSHA 30
Connector Hazard Training
Other
If other, describe here:
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*Please provide supporting documentation. Examples are: Sign in sheets or employee training records
Upload File
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Max file size: 20MB
Upload File
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Max file size: 20MB
Upload File
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Max file size: 20MB
Upload File
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Max file size: 20MB
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