Safety Award Submission Form

IISC Hazard Control Safety Award Submission Form

IISC Member companies can submit up to 5 projects per location within the Iowa-Illinois membership territory. Each member company is allowed one plaque per location. If you would like additional plaques for one location (ie, for different departments) please contact us for information on costs.
Contact Name *

First Name Last Name
Email *
example@example.com
Company Name *
This is how your company name will be listed in any awards list, in publications, and printed on your plaque or any other awards you may receive (if applicable).
I need (choose one): *

Year Tag New Plaque (for first time applicants or your current plaque is full) Unsure (we will check for you and order accordingly)
Mailing Address: If you are unable to pick up your award at the Awards Luncheon *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Upload your slides here *

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Please only submit PowerPoint files. PPT slides should be on a blank white slide. Please include company name in the file name.
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IISC Hazard Control Safety Award Submission Form