2019 Safety Award Application

Address

Phone Number

- Area Code Phone Number
Contact Name
Experience Modification Rate:
An insurance premium modifier based on both length of service and the total amount of premiums paid over that time period.
Brief description of business:
Brief description of safety efforts:
How have the efforts improved the workplace or work site?
How do your employees support the safety efforts?
What impact has the SUHBA Safety Program and Resources we've offered had on your safety program?
Safety Award Category:

General Contractor Trade Contractor Service Supplier
Safety training is sponsored through a workplace safety grant from the Utah Labor Commission.
Should be Empty: