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 membership. If you would like additional plaques (ie, for different departments) please contact us for information on cost.
**If you are also submitting for the Community Enrichment Award please fill out the Community Enrichment Award form separately**
https://form.jotform.com/222285536613153
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 Breakfast in April
*
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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