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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
*
2018
*
2018
*
2018
*
2018
*
2017
*
2017
*
2017
*
2017
*
2017
*
2016
*
2016
*
2016
*
2016
*
2016
*
How many days/hours since last lost time injury?
*
Tracked hazards to resolution:
*
Yes
No
Written safety manual available:
*
Yes
No
Submit
ABOUT MAM
Administration
Board of Directors
Our Founder Jack T. Gentry
Made in Missouri USA
Advocacy
Contact MAM
>
Subscribe for Updates
MEMBERSHIP
Member Application
BENEFITS
ONESource Overview
HEALTHSOURCE
BENEFITSSource
ANCILLARY BENEFITS
LEGISLATIVESOURCE
LOGISTICSSOURCE
PEOPLESOURCE
PERFORMSOURCE
PROTECTSOURCE
SKILLSOURCE
SUPPORTSOURCE
TECHSOURCE
TRAVELSOURCE
WEALTHSOURCE
EVENTS
2020 Events
Past Events
Founder Awards
Be a Presenter
RESOURCES
Government 101
>
Pledge to Americas Workers
President Trump's Cabinet
Plant Tour How To
>
Schedule Plant Tour Form
Government Links
House Floor
News
>
MAMStrong Blog
MAM in the Media
Submit Your News
International Trade
PARTNERSHIP
Login
How to Login
Member Directory
