Safety Council of the Ozarks - 2012 Ozarks Corporate Safety Awards Application

Making our world a safer place.

2012 Ozarks Corporate Safety Awards Application

The information will only be used by the sponsors and judges of the 2012 Ozarks Corporate Safety Award.

Please complete the following information for entry in the 2012 Ozarks Corporate Safety Award Program. Entry deadline is March 30, 2012. Late entries will not be accepted.

* denotes a required field

Full Name of Organization*

(will be inscribed on award certificate)

Contact Person *

Contac Person Title

Address*

City*

State*

Zip*

E-mail*

Telephone*

Fax

1. Number of Employees:

2. In how many locations:

3. Number of shifts normally run:

4. Total annual hours worked:

5. Number of recordable cases in 2011:

In 2010:

In 2009:

6. Number of lost workday cases in 2011:

In 2010:

In 2009:

7. Current year Experience Modification*:

Previous year:

*The Experience Modifier is required in order to be judged.

Briefly describe your company's safety program (development, administration and training.).

I. MANAGEMENT COMMITMENT

A. Please check below which of the following apply to your company.

Safety Committee

Regular Safety Meeting of the Safety Committee (with minutes kept of meetings)
Number held in 2011:

Regular Safety Inspections by the Safety Committee (with report issued)
Number held in 2011:

OSHA Voluntary Inspection Program

Early Return to Work Program

Lockout-Tagout Training

Material Safety Data Sheet (MSDS) Training

NFPA 70E Training

Other (describe):

B. How many safety related activities (documented safety meetings, inspections or accident investigations) are attended by:

The Owner

General Manager

Safety Director

Hourly Production Personnel

Production Manager

Controller/H.R. Manager

Comments:

II. EMPLOYEE INVOLVEMENT

How many of your company's safety policies/procedures have been developed with significant employee input?
Please describe:

How many documented plant wide inspections were performed by company supervisory personnel in 2011?

Do you track the hazards to resolution? Yes No

How many documented department specific inspections were performed by non-supervisory personnel in 2011?

Do you track the hazards to resolution? Yes No

Employee safety incentive program? Yes No

Please Describe

III. TRAINING COMMUNICATION

Written Safety Manual (Please fax a copy of your manual index to 417-869-2133 attn: Debra Biggs.)

Employee Safety Training

Bilingual

Please describe content and method:

What safety programs and activities should the Safety Council of the Ozarks pursue?

Please describe any other unique safety program or plant safety innovation not covered above.

Form Completed By

Name *

Title *

I hereby certify that the information included in this application form is factual and accurate.