Safety Excellence Award Application

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.

* Indicates required field

Company Name *

Company Address *

Line 1

Line 2

City

State

Zip Code

Country

Contact Name *

First

Last

Phone Number *

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 *

EMR *

Year *

EMR *

Year *

EMR *

Upload letter of explanation (if applicable) *

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 *

Recordable Incident Rate

Untitled *

B. Total number of Lost Time on OSHA 300A form

Untitled *

Lost Time Incident Rate

Untitled *

C. Total number of DART on OSHA 300A form

Untitled *

DART	Untitled *

D. Total number of OTHER on OSHA 300A form

Untitled *

E. Employee hours worked last year

Untitled *

F. Average number of employees

Untitled *

G. Were there any fatalities?

Choose One *

Yes No

If yes, how many fatalities? *

* 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 *

Max file size: 20MB

Upload File *

Max file size: 20MB

3. Have You had any OSHA citations for the calendar year 2020? *

If so, what severity? *

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 *

Upload File *

Max file size: 20MB

5. When was the last revision of your Health & Safety Policy?

Date of last revision *

6. Are the costs of individual accidents kept? Please answer yes or no.

Select One *

If yes, how are they reported? *

7. Do you have an orientation program for new hires? Please answer yes or no.

Select One *

If yes, describe the program briefly: *

8. Do you submit site specific safety plans? Please answer yes or no.

Select One *

If yes, how often? *

*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 *

Please provide a safety related “write up” for the year 2020. Points will be deducted if not submitted. *

Max file size: 20MB

10. Do you conduct frequent project safety inspections? Please answer yes or no.

Select One *

If yes, how often? *

11. Do you have a 100% Fall Protection 6’ and above policy for all projects? Please answer yes or no.

Select One *

12. Do you have a daily Stretch & Flex program? Please answer yes or no.

Select One *

13. Do you require supervisors to perform daily JSA Job Safety Analysis or Pre-Task meetings? Please answer yes or no.

Select One *

Please provide a site pre task or JSA from 2020. Points will be deducted if not submitted. *

Max file size: 20MB

14. Do you have a Behavioral Based Safety Program?

Select One *

If yes, how are they reported AND what do you do with the information? *

15. Do you provide the following training for all Ironworkers?

If other, describe here: *

*Please provide supporting documentation. Examples are: Sign in sheets or employee training records

Upload File *

Max file size: 20MB

Upload File *

Max file size: 20MB

Upload File *

Max file size: 20MB

Upload File *

Max file size: 20MB

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