Thread 1878860 - Chapter Safety Award Application 2019

Chapter Safety Award Application 2019

ABC Mississippi
GENERAL INFORMATION
Company Name*
Safety Contact*

First NameLast Name
Job Title*
Phone Number*

Area CodePhone Number
Email Address*
example@example.com
2018 COMPANY SAFETY INFORMATION
2018 Average # Employees
2018 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 link above to download.
Total Recordable Cases Incident Rate
Formula required. Click link above to download.
2018 EMR
Experience Modifier Rate (EMR) is available from 2018 Workers' Comp Policy or Insurance Agent.
2017 EMR
Experience Modifier Rate (EMR) is available from 2017 Workers' Comp Policy or Insurance Agent.
2016 EMR
Experience Modifier Rate (EMR) is available from 2016 Workers' Comp Policy or Insurance Agent.
# of Federal or State OSHA Inspections
# OSHA Citations Issued in 2018
$ Paid for OSHA Fines in 2018
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 writingType option 4
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
Total number of selected Checkboxes
Should be Empty: