• Safety Awards

  • General Information

  • Facility Type: *

  • Please enter the official and exact name of the facility and its owner as you would like it to appear on the award. The information provided may be used directly for award printing, so ensure accuracy by using the official names. Any variations or typos in the entered names may be reflected on the award.

  • Large or Small System:

  • Safety Program Information

  • Does your facility have a formal safety program? Only Facilities with formal written Safety Programs are eligible for an Award.*
  • Does your facility have a safety committee?*
  • Does your facility have a designated safety officer/representative?*
  • Does your facility have a safety awards program?*
  • Does your facility have a formal program for disciplinary action of safety infractions?*
  • Does your facility have a formal training program for safety related topics?*
  • Does your facility conduct routine inspections to identify safety concerns?*
  • Does your facility have a working relationship with the local emergency service agency?*

  • Safe Work Practice Information (Applies to Full Calendar Year)

  • IMPORTANT: Shipping Address

    All Safety Awards will be drop shipped directly from the supplier. Please provide a physical address capable of recieving mail. Saftey award placards cannot be drop shipped to PO Boxes.

  • Disclaimer

  • By submitting the information in this entry form, you are certifying the following:

    All information in this application is true and honest

    Permission for the AZ Water Association Awards Committee to share the application materials for the purposes of selecting an award recipient

    Please take the time to verify that all submitted information is correct.

    A printable copy of the information submitted is available upon completion of the online form.

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