INTRODUCTION

NAWIC’s Safety & Health Awareness Committee is pleased to offer the Safety Excellence Award to recognize NAWIC member companies which recognize safety as a corporate value and commitment.  These companies have implemented excellent safety and loss prevention programs.  The means of achieving this include employee training, management committee initiatives and program innovation. 
The three categories of awards are to companies by:  1) Contractor 2) Sub-Contractor and 3) Construction Related.
Eligible participants must employ a NAWIC member or Member At-Large.  Members submit their applications to their Safety Chair or President if no chair available. (Chapter Safety Chairs/Presidents should recuse themselves from judging if their own company is an applicant.) At-Large Members submit directly to the Regional Safety & Health Awareness Chairperson. The application is evaluated on several levels.  First review is by the member’s Chapter.  Chapter winners are then submitted to the Regional Safety and Health Committee Chair.  Regional winners are then submitted to the National Safety and Health Committee Chairs.  National winners will be selected from Regional submissions by an unbiased, independent party.

The Chapter determines its own deadline for submitting the awards (recommended date is February 1, 2015). Each Chapter will then forward their top three (3) in each category to their Region’s Safety & Health Awareness Chairperson. (Region Chairpersons should recuse themselves from judging if their own company or subsidiary is an applicant to avoid any sense of conflict of interest.) The deadline for your Chapter to submit their selections to your Region’s Safety &  Health Awareness Committee Chairperson is not later than March 1, 2015.

The Region Safety & Health Awareness Committee Chairperson will then identify their top choice(s) for recognition at their Region’s Spring 2015 Forum. Winners of the Region Safety Excellence Awards will then be forwarded to the National Safety & Health Awareness Committee Chairperson, Leah Curran.  Send applications to nawicsafety@gmail.com.  Judging for the National award will be done by an unbiased party who will then identify the National Winners. The winners from each of the three categories will be awarded at Annual Meeting & Education Conference 2015 in Nashville, Tennessee.

		Checklist:
			
1)	Include a copy of your corporate OSHA 300A Summary for 2014
2)	Do not exceed the one page summary requested in Part 3 #2
3)	Make sure the application is signed
4)	Be sure to get application to your chapter chair by the deadline
5)	Chapter chairs—make sure winner’s applications to your Regional Chair by deadline of March 1, 2015
6)	Regional Chairs request plaque from National for your winners to be awarded at your FORUM  Crissy Ingram
7)	Regional Chairs make sure Regional winners to National Chair by May 31
nawicsafety@gmail.com

SAFETY EXCELLENCE AWARDS APPLICATION: PART I

Part I applies to your parent corporation and its safety statistics for 2014

A.		FIRST, identify if you are a contractor (self performs labor, or works as a Prime or General Contractor), a subcontractor (self performs labor for a Prime or General Contractor or Owner/Client OR a construction-related company (supports/supplies/advises the industry)

CHOOSE the appropriate category (circle one)
a.  CONTRACTOR	b. SUBCONTRACTOR	c. CONSTRUCTION-RELATED FIRM B.   What is your company’s primary NAICS Number?                                Secondary?                         

C.  Include a copy of your corporate OSHA 300A Summary for 2014 with this application.

1.   Total number of labor hours worked by your company  	
2.   Total number of labor hours worked by your division    	
3.  Total number of fatalities (column G) see NOTE

NOTE: If your organization, parent or subsidiary company or one of your subcontractors experienced an occupational-related fatality on one of your projects involving an employee(s) during 2014, you will not be eligible for the Safety Excellence Award in 2015. 

4.   Total number of cases with DAYS AWAY from work (column H)   	
5.   Total number of cases with JOB RESTRICTION or JOB TRANSFER (column I)  	
6.   Total number of other recordable cases (column J)	 	
7.   Total number of days of job transfer or restriction (column K)   	
a.   Total number of days away from work (column L)	 	
                       8.  What is your company EMR for 2012?  	  (is it Interstate or Intrastate?)
9.  What is your company EMR for 2013?  	  (is it Interstate or Intrastate?)
10. What is your company EMR for 2014?  	  (is it Interstate or Intrastate?)
11. IF KNOWN, what is your company EMR for 2015?  	 (is it Interstate or Intrastate?)

If your company is a branch, subsidiary, division of, or a member of a larger corporate entity and you receive either financial or technical support from the larger entity please identify who the corporate entity is here.                                                                  

12. IF APPLICABLE, has your BRANCH, SUBDSIDIARY or DIVISION (where the NAWIC Member is employed) had any cases of DAYS AWAY or JOB RESTRICTION/JOB TRANSFER CASES?

a.   How many DAYS AWAY CASES?    	
i.   How many DAYS AWAY?  	
b.   HOW MANY JOB RESTRICTION CASES?	 	
i.   How many JOB RESTRICTION DAYS?  	

Who is completing this form?

NAME  		 JOB TITLE  	

WHO IS THE NAWIC MEMBER SUBMITTING THIS FORM?   	______________________  

WHAT REGION # & CHAPTER # AND NAME 	___________________________________

SAFETY EXCELLENCE AWARDS APPLICATION: PART II

Part II applies to your (the NAWIC Member’s) office, branch, division or subsidiary
                    1.   Do you employ a Safety Manager or Director at your location?  	
2.   Do you have a safety plan and emergency/crisis response plan for your office staff?  	
3.  Do you have a health promotion program for your employees and their families? (smoking secession/weight loss/heart health/offer CPR & First Aid)  	
4.   Who oversees field (site/project) safety?  	
a.  If not full time, how frequently are site/project visits scheduled? (Circle all applicable)
i.  DAILY		iii.  AS NEEDED
ii.  WEEKLY	iv.    OTHER
5.   What are the minimum educational criteria for site safety management?  	
6.  Is there someone within your company trained in basic first aid and CPR at every location where there is not a medical office on site?  	
7.   Do you utilize a site specific safety plan?  	
                       8.  Do you utilize a site specific emergency/crisis response plan?  	
a.  If applicable, who develops the site specific safety plan and emergency/crisis response plan?  	
9.  Does your company offer a site specific orientation for all employees who are new to a project?

10. Do you offer or subscribe to any training programs to your employees, such as OSHA 10 Hour
Outreach/OSHA 30 Hour Outreach/MUST/MOST/Other programs? (Circle all applicable)
        a.   Are these offered to all field employees or field supervisors and above (Circle all
applicable)
b.   Is any training shared?  	
11. Do you hire any workers whose first language is not English?  	
a.   How do you ensure that they know and understand safe work practices?  	

12. Do you have a substance abuse prevention plan?  	
a.   Does it consist of pre-hire, annual, random, post-accident drug testing?  	
b.   Does it include alcohol testing (swab or BAT)?  	
13. Do you have a fleet of company owned vehicles?  	
a.  Are vehicle operators’ driving records checked prior to authorizing them to operate a
company owned vehicle?  	
b.   Does your program consist of defensive driving training?  	
c.   Do you have a “NO TEXTING”/HANDS FREE PHONE USE policy while operating company
owned vehicles or while on company owned business?  	
d.   How many company vehicles are at your location?  	
i.   How many miles (approximate) driven annually from your location?  	
ii.  How many “at fault” vehicle accidents occurred from the vehicles driven from
your location?  	
14. Do you develop pre-task plans for your field work?  	
a.   Who develops these for the project?  	
15. Do you conduct daily prestart meetings with your field crews?  	
a.   Who conducts the meetings?  	
16. Do you conduct weekly Tool Box Talks with your field crews?  	
17. Do you have a 6 foot fall protection rule?  	
a.   Do you utilize a Controlled Access Zone/Controlled Decking Zone (CAZ/CDZ) plan?  	
b.   Do you utilize a Safety Monitoring Plan?  	
If the answer is yes to 17.a or 17.b please provide a brief paragraph on separate sheet as to when/why you use these exceptions.
18. Do you conduct field observations?  	
a.   Who does the observations?  	
i.   How often are they conducted?  	
19. Does your company utilize a behavior based/people based safety system?  	
20. Do you share leading indicators with the field crews?  	
21. Do you belong to any local (chapter) construction organizations such as AGC/ABC?  	
a.   Do you have anyone who sits on their safety & health committees?  	

SAFETY EXCELLENCE AWARDS APPLICATION: PART III

Part III applies to your company’s safety & health commitment

1.	Does your safety program have a commitment statement from your company
CEO/President/Owner? ______  If yes please attach.
2.	What makes your safety program better than your competitors? (What is your competitive edge ? – be specific.) (Attach to the application using no more than 1 page of Times New Roman, 12 Font.)

Reviewed by:  	 Printed Name/Title and Signature of Company’s/Location’s Most Senior Executive

Date