Test - SEAA - Missouri Association of Manufacturers

ABOUT US
MEMBERSHIP
- Member Application
Contact Us
- Manage Subscriptions
BENEFITS
EVENTS
RESOURCES
PARTNERSHIP
Login
- How to Login
- Member Directory

2018 SAFETY EXCELLENCE AWARDS APPLICATION

DUE March 22, 2019 @ 5pm cst

* Indicates required field

Company Name: *

Contact Name: *

First

Last

Phone Number *

Email *

Title *

Corporate Address: *

Line 1

Line 2

City

State

Zip Code

Country

Facility Address: *

Line 1

Line 2

City

State

Zip Code

Country

Number of Facilities *

Additional Locations (Cities): *

NAICS: *

Awards & Certifications: *

VPP SHARP OHSAS 18001 ISO

BLS Rate: *

OTHER: *

AWARD CATEGORIES

Select one award category per application. MAM Safety Excellence Award Committee reserves the right to change the award category for any application.

Award Categories *

Safety Innovation Award (Corporate, Multi-site or Single-site) Most Improved (Corporate, Multi-site or Single-site) Safety Manufacturing Company of the Year (Corporate, Multi-site or Single-site) Leader of the Pack (Corporate, Multi-site or Single-site) Horizon Award (Individual –or– Corporate, Multi-site or Single-site) Safety Champion of the Year (Individual) Safety Professional of the Year (Individual)

Company Data

Data represents (select one): *

Corporate (all facilities) Multi-site (two or more facilities) Single-site (one facility)

Full-time Employees *

Part-time Employees *

Percentage of Temporary Employees: *

Employees per Shift:

1st Shift *

2nd Shift *

3rd Shift *

Total hours worked (calendar year)

Number of recoverable nonfatal work-related injuries and illnesses (for MAM use only)

Number of days away from work cases
(for MAM use only)

Number of job transfer or restricted work activity cases

Experience Modification

2018 *

2017 *

2016 *

How many days/hours since last lost time injury? *

Tracked hazards to resolution: *

Yes No

Written safety manual available: *

Yes No

Submit

1335 E. REPUBLIC RD., Suite K
SPRINGFIELD, MO 65804
PHONE: 417-863-7262

About Us
Membership
Made in Missouri USA
ONESource
Events & News
Resources
Partnership
Contact US

Credit Card Processing