Chapter Safety Awards 2026

Chapter Safety Awards

2026 Application
From
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
2025 Safety Information
2025 Average # Employees*
2025 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.
2025 EMR*
Experience Modifier Rate (EMR) is available from your Workers' Comp Policy or Insurance Agent.
2024 EMR*
Experience Modifier Rate (EMR) is available from your Workers' Comp Policy or Insurance Agent.
2023 EMR*
Experience Modifier Rate (EMR) is available from your Workers' Comp Policy or Insurance Agent.
# of Federal or State OSHA Inspections in 2025*
# OSHA Citations Issued in 2025*
$ Paid for OSHA Fines in 2025*
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.
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
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
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
Weekly safety meetings are held by upper managementManagement gives an overview of safety activitiesAll accidents are reviewedMonthly safety meetings are held by upper management
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
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
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
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
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
Meetings are held weeklyConducted by superintendents and foremenRecords are kept on the attendance and topic presentedManagement attends periodically
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
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
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
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
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.
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 Lena McGuffin at ABC Mississippi, 5165 Old Brandon Road, Pearl, MS 39208. This is required to complete your application.
2025 OSHA 300A Summary Log (Combined For All Jobs)*

Browse Files

Cancelof
2025 Experience Modifier Rate (Indicated on Worker's Comp Policy or Insurance Statement)*

Browse Files

Cancelof
Substance Abuse Policy & Testing Procedures*

Browse Files

Cancelof
Yes, please.No, thank you.
Payment

$125 Application Fee
Pay OnlineSend Invoice
Price
Calculation

Pay Online

USDDescription

Credit Card

First Name

Last Name

Credit Card Number

Security Code

Expiration Month

Expiration Year

Billing Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

Should be Empty:

Chapter Safety Awards

2025 Safety Information

Safety Evaluation

Documentation

Payment