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test-project safety award application
Casey Damrose
2021-02-19T11:42:10-05:00
Member Information
Member (Company) Name:
*
Contact
*
First
Last
Address
*
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
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Delaware
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Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Phone
*
Fax (optional)
Email
*
Project and Client Information
Project Name
*
Client (Company) Name
*
Contact
First
Last
Address
*
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Phone
*
Fax (optional)
Email
*
Project Safety Award Questionnaire
How many on-site manhours did your company accrue on the project?
*
Did your company have any OSHA recordable incidents during the project?
*
Yes
No
Did your company suffer any property damage incidents valued in excess of $10,000 during the project?
*
Yes
No
Does your company have a written Health and Safety Program?
*
Yes
No
Did your company enforce a Site Specific Safety Plan?
*
Yes
No
Does your company complete weekly safety meetings?
*
Yes
No
Does your company have an on-site person trained in first aid/CPR?
*
Yes
No
Do all of your workers have an OSHA 10 hour certification card?
*
Yes
No
Do at least one of your supervisors have an OSHA 30 hour certification card?
*
Yes
No
Briefly describe the scope of your company’s involvement on the project:
*
In a short paragraph explain one safety lesson you’ve learned from this project:
*
*
Check this box if you attest that the answers on this questionnaire are true and accurate.
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