TACA Safety Contest Entry Form

TACA Safety Contest Entry Form
PLANT/ FACILITY MAINTENANCE DIVISION
Annual Summary of Injuries - Calendar Year 2021

DEADLINE IS APRIL 25, 2022.
1. The safety contest will cover calendar year 2021.
2. All members with plants/facilities located in the state of Texas are eligible to participate. Participants will be judged as independent operating units not by company. This may be as a single plant/facility or may be several plants/facilities using a floating mechanic fleet. Participants cannot use the same information to enter as a single plant/facility and as a floating fleet.
3. Each participating unit must submit the total number of actual hours worked, total number of recordable injuries and total number of DOT accidents and vehicle accidents involving plant/facilities mechanics/maintenance employees. Using these statistic and the formula in number five, calculate your incident rate.
4. Reports are to be submitted annually on forms furnished by the Association.
5. Recognition will be based on Incident Rate.
  Incident Rate = Total reportable Accidents (*OSHA Standard Recordable Injuries & Vehicular Accidents) x 200,000 divided by total number of actual hours worked.
6. The group having the lowest Incident Rate in its group for the year will be recognized. Where more than one group within the group has the same Incident Rate, rank will be determined according to the number of actual hours worked. No participant will be recognized with an incident rate higher than the national average per S.I.C code, published by Bureau of Labor Statistics. Any Fatality is a disqualifying event.
7. Awards will be made to the unit with the lowest Incident Rate in each of the following groups:
  
  Group 6A                          Over 90 Employees
  Group 5A                          61 to 90 Employees
  Group 4A                          31 to 60 Employees
  Group 3A                          16 to 30 Employees
  Group 2A                          8 to 15 Employees
  Group 1A                          1 to 7 Employees
8. Awards will be given to the winner and runner-up in each group. All shop groups with Zero Lost Time will receive a Zero Lost Time Certificate.
  
  *Reportable accidents: 1 Vehicular Accident
  
  *OSHA Standard Recordable Injury-Injured employee unable to return to next scheduled duties.
Please fill all blanks on this form. Incomplete forms will be disqualified. Entries due by April 25, 2022.
Plant/ Facility Identification
Plant Name *
Location *
Company Name *
Address *
Phone Number *
Actual Hours Worked *
Total Employees *
Total Number of Plants/Facilities operating in 2021 for this category *
Total Fatalities *
Injuries Occurring in Calendar Year 2021
a. Number of Non-Fatal Recordable Injuries *
b. Number of Fatalities *
c. Number of Reportable Accidents (Vehicular Accident) Involving Plant/Facility Employees *
Incident Rate *
Incident Rate = Total Reportable Incidents (OSHA Standard Recordable Injuries & Vehicular Accidents) x 200,000/Total number of Actual Hours Worked
Last Lost Time Accident
Month/Day/Year *
Contact and Verification
Name *
Person completing the form
Title *
Person completing the form
Email *
example@example.com
Date *
Verification

I verfy that all of the above information is accurate to the best of my knowledge.
Please verify that you are human *
Should be Empty:

PLANT/ FACILITY MAINTENANCE DIVISION

Annual Summary of Injuries - Calendar Year 2021

Please fill all blanks on this form. Incomplete forms will be disqualified. Entries due by April 25, 2022.

Plant/ Facility Identification

Injuries Occurring in Calendar Year 2021

Last Lost Time Accident

Contact and Verification