TPS - Safety Grant Program Application

Safety Grant Program Application

The Safety Grant Program is an opportunity provided by the TPS JSIF for the benefit of its Fund members. By applying for this Grant, the Fund member understands and acknowledges there is no guarantee of acceptance, approval, and/or payment.
- Learn more about the TPS Safety Grant Program.

Member Name
Submitter Name and Title
Submitter Email
example@example.com
Submitter Signature
Department
Applicant’s Phone
Format: (000) 000-0000.
Member Mailing Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Applicant’s Phone
Format: (000) 000-0000.
1. Please describe the safety equipment/services/training you are considering purchasing.
Intended purchase, installation or completion date for your project.

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
2. Why is this safety equipment/services/training needed. If this is to replace old or obsolete equipment, please attach photos below.
3. How will this safety equipment/services/training help to reduce workplace injuries and provide your entity with a safer work environment?
4. Cost (or quote) of equipment/service. Please attach to application below.
5. Have you committed Funds for your portion of this activity?
6. Have you applied for or received grants or Funding from other sources for this endeavor?
If Yes, from whom?
If Yes, how much?
Upper Management Name and Title
Upper Management Approval - Email Address
example@example.com
Upper Management Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Upper Management Approval - Signature
File Upload

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