Chapter Safety Awards 2023

Chapter Safety Awards

2023 Application
Form Name
Company Name*
Primary Safety Contact*

First NameLast Name
Job Title*
Phone Number*

Area CodePhone Number
Email Address*
example@example.com
Information Confirmed By (CEO Name):*

CEO FirstCEO Last
2022 Safety Information
2022 Average # Employees*
2022 Total Hours Worked*
Total # Work Days Lost*
Information available from the OSHA 300 Log.
Total # OSHA Recordable Cases*
Information available from the OSHA 300 Log.
Lost Time Cases Incident Rate*
Formula required. Click button below to view.
Total Recordable Cases Incident Rate*
Formula required. Click button below to view.
2022 EMR*
Experience Modifier Rate (EMR) is available from your Workers' Comp Policy or Insurance Agent.
2021 EMR*
Experience Modifier Rate (EMR) is available from your Workers' Comp Policy or Insurance Agent.
2020 EMR*
Experience Modifier Rate (EMR) is available from your Workers' Comp Policy or Insurance Agent.
# of Federal or State OSHA Inspections in 2022*
# OSHA Citations Issued in 2022*
$ Paid for OSHA Fines in 2022*
Safety Evaluation
The following evaluation is provided to help you assess your firm’s safety program. Sixteen (16) key elements are addressed. Each element contains various descriptions. Mark (x) each description that most accurately describes your firm’s performance.
A. EXECUTIVE MANAGEMENT POLICY STATEMENT ON SAFETY

Is in writingKnown to all employeesIs a part of the safety manualSets boundaries for the safety programEmphasizes management’s commitmentSigned by the CEOIs included in the mission statement
B. RESPONSIBILITY FOR SAFETY DEFINED

Responsibility for safety is defined for all levels of the firmIs in writing and is part of the safety manualSuperintendents and foremen have key responsibilities outlined in writing
C. SAFETY PROGRAM GOAL SETTING

Written goals and objectives are set to be achieved through the safety program (based on needs or problems)A strategy is developed to accomplish the goalsFeedback from those responsible for achieving results is requiredWritten audits are made to measure performanceBoth long term and short term goals are considered
D. MANAGEMENT SUPERVISORY MEETINGS

Weekly safety meetings are held by upper managementManagement gives an overview of safety activitiesAll accidents are reviewedMonthly safety meetings are held by upper management
E. PRE-PLANNING FOR JOB SITE SAFETY

Pre-job safety planning is required at the bid stageA check list is used by the superintendent and foremen to assure that all hazard exposures are consideredNecessary equipment is provided and precautions are taken prior to or at the start of the job not after problems have been encountered
F. EMPLOYEE PARTICIPATION

Employee participation is encouraged in such activities as (demonstrations of proper personal protective equipment (PPE), testimonials, tool box talks, HAZCOM training, accident reporting, fire protection training, etc.Employees are encouraged to participate in site inspections, safety rule development, hazard recognition, and accident investigation
G. NEW EMPLOYEE ORIENTATION

Formal written orientation program is in effect for all new or transferred employeesA record is maintained showing date, person conducting the orientation and the items coveredOrientation includes training on: safety rules, HAZCOM/GHS, major hazard exposures of the job, PPE, and emergency proceduresManagement concern for safe job performance is stressedEmployee signs orientation documentation
H. SAFETY RULES

Rules are publishedAll employees are aware of the rulesRules are concise and easy to understandRules are enforced equally among all employeesRules are updated as neededWritten or oral testing of the employees understanding of the rules is verified or documented
I. EMPLOYEE SAFETY TRAINING

Based on a training needs assessment, formal safety training is provided and documented in areas such as: hazard recognition, First-Aid/CPR, hazard/standard specific OSHA topics, heavy equipment safety, and trade specific safety such as electrical safety, etc.Qualifications of all safety instructors are reviewed and verified
J. SAFETY TOOLBOX MEETINGS

Meetings are held weeklyConducted by superintendents and foremenRecords are kept on the attendance and topic presentedManagement attends periodically
K. INSPECTIONS

Weekly job site inspections are conducted by the safety coordinator, superintendent or foremanCritical safety items are identified and correctedWritten report is submitted on the results of the inspectionInformation learned is shared with all job sites
L. SUPERVISORY SAFETY TRAINING

Formal Training Includes: First Aid/CPRFormal Training Includes: Emergency Reporting ProceduresFormal Training Includes: Job Safety AnalysisFormal Training Includes: Job Site Safety InspectionsFormal Training Includes: Hazard RecognitionFormal Training Includes: OSHA 10-Hour or greaterFormal Training Includes: Accident InvestigationFormal Training Includes: Job Safety PlanningCompany has in-house facilities for trainingSupervisors have access to a safety professional within the company
M. USE OF PERSONAL PROTECTIVE EQUIPMENT (PPE)

Analysis made to determine PPE needsEmployees are trained in the use and maintenance of PPEOnly approved PPE is usedPPE is provided to employees, except shoesEmployees are aware of the disciplinary consequences of not using PPEAnnual audit/review of the program
N. PERFORMANCE AUDIT

Audits are made at least semi-annually to determine if safety work is effectiveStandards exists by which to measure performanceSafety performance becomes a part of the overall rating of supervisorsStrengths and weaknesses are discussed with individual supervisorsSuperintendent’s and/or foremen’s safety performance is tied to compensation
O. SUBSTANCE ABUSE

Company policy contains strict rules regarding drug and alcohol use.Company does drug testing for pre-hire.Company does drug testing for post accident.Company does drug testing for reasonable suspicion or cause.Company does random drug testing.Company maintains counseling and testing records.
P. RECORD KEEPING - Records are kept on:

Employee OrientationsInspectionsTrainingAccident InvestigationsFirst Aid TreatmentOSHA Log-Form 300Hazard Communication GHS
Total Score
Documentation

Please upload the following required documentation. A hard copy of your Company Safety Program and Policy manual is required. Soft copies are not accepted. Please deliver your hard copy to Sherry Dunlap at ABC Mississippi, 5165 Old Brandon Road, Pearl, MS 39208. This is required to complete your application.
2022 OSHA 300A Summary Log (Combined For All Jobs)*

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2022 Experience Modifier Rate (Indicated on Worker's Comp Policy or Insurance Statement)*

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Substance Abuse Policy & Testing Procedures*

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Would you like a follow-up evaluation of your safety program?*

Yes, please.No, thank you.
Payment

$100 Application Fee
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Chapter Safety Awards

2022 Safety Information

Safety Evaluation

Documentation

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