2021 SOUTHERN OREGON OCCUPATIONAL SAFETY & HEALTH CONFERENCE ASSP Award Application

Best of the Best Safety Committee Award _

Section 1	Company Information

Company	Contact Person
Division	Number of Employees
Address	North American Industrial Classification System Code
Phone	To Look Up NAICS Code: https://www.naics.com/search/
Email	Fax

Section 2	Injury and Illness Statistics

Provide Injury and Illness statistics for each year:

Year	Total Number of Recordable	Number of regular and	Incident Rate:
Injuries & Illnesses on OSHA	overtime hours for all	Equals Number Recordable Injuries
300 A Summary	employees for the year	Times 200,000 / Exposure hours
2020
2019
2018

Section 3	Application Checklist

Complete form Sections 1 & 2 by typing in each shaded field and printing

Attach 2-page type written summary describing specific accomplishments

Attach a list of current safety committee members

Attach copies of safety committee minutes if applicable from past 12 months

Attach quarterly inspection findings for this same period

Attach any other supporting documentation that supports your achievement

Deadline: Applications must be received by August 27, 2021 Mail to SAIF: 990 N. Phoenix Rd. Ste. 101, Medford, OR 97504 (Questions: David Hanson davhan@saif.com 541.857.4236) Incomplete Applications will not be accepted

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Best of the Best Safety Committee Award _

Please submit a written summary of not more than two (2) type written pages of safety committee accomplishments, and also include all items listed on first page of this application.

One Best of the Best Safety Committee Award winner will be selected by the awards committee that demonstrates a superior safety committee effort during the award period. The Best of the Best Award will be given to the committee who outshines the rest in preventing harm to workers, promoting the cause of safety and health and making safety fun and engaging for all employees.

If selected, a photo will be requested. Incomplete applications will not be accepted!

Awards Committee Notes:________________________________________________________

Deadline: Applications must be received by August 27, 2021. Mail to SAIF: 990 N. Phoenix Rd. Ste. 101, Medford, OR Incomplete Applications will not be accepted SAIF Offices are not open for drop-offs Call to arrange delivery If you have questions or to arrange packet delivery: David Hanson davhan@saif.com (541)-857-4236 _____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

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