SAFETY AWARDS ENTRY FORM
Company
*
Contact Person
*
E-mail
*
Phone Number
*
Format: (000) 000-0000.
Construction Type
*
Please Select
Highway
Federal & Heavy
Utility Infrastructure
Building
Associate/Specialty
Section (G) Number of Fatalities
*
Zero Fatalities
Other
Section (H) Number of Cases with Days Away from Work
*
Zero
Other
Section (I) Number of Cases with Job Transfer or Restriction
*
Zero
Other
Section (J) Number of other Recordable Cases
*
Zero
Other
Total Hours Worked by All Employees
*
CAWP/H2AP Awards Information
Section (H) Number of Cases with Days Away from Work for Heavy, Highway, Railroad, and Utility Work performed within the 33 counties of western Pennsylvania
*
Zero
Other
Work Hours for Heavy, Highway, Railroad, and Utility Work performed within the 33 counties of western Pennsylvania
*
Please verify that you are human
*
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