25 th Annual Safety Awards of Excellence

Transcription

1 25 th Annual Safety Awards of Excellence Sponsored by the Safety & Health Council Don t miss out on your opportunity to earn one of the prestigious Safety Awards of Excellence! If you are a first time applicant, contact the AGC of California Safety Office for assistance in completing your application. The AGC of California Safety Awards of Excellence recognizes contractors for their outstanding safety programs in the following categories: Contractor Safety Awards of Excellence based on three categories of worker hours in California o Building Under 200,000 worker hours 200, ,000 worker hours 500,001-1 million worker hours Over 1 million worker hours o o Heavy/Civil/Highway Under 200,000 worker hours 200, ,000 worker hours 500,001-1 million worker hours Over 1 million worker hours Specialty Contractor Under 500,000 worker hours 500,001-1 million worker hours Over 1 million worker hours Safety on a High Hazard Project Unique Safety Application Individual Safety Effort of a Project Superintendent Safety Effort of a Project Team (New Category) Associate Member Contribution to the Industry Harry Eckstein Safety Professional of the Year The award application package is available online on the AGC Safety and Health webpage, or by calling AGC of California at (916) starting June 25, The application is available in PDF and Word formats. The preliminary round of judging will be at the AGC of California West Sacramento Office on August 29-30, The final judging will be live company presentations held on September 27, 2012 at the Sheraton Grand in Sacramento. The awards luncheon will be held during the 2012 AGC Fall Conference, October 24-26, 2012 at the Hyatt Grand Champions Resort in Indian Wells. Page 1

2 GENERAL INFORMATION 1. Direct your questions about the awards program or about your application to the AGC of California Safety Office at (916) , and/or Kate Smiley, Safety Manager at 2. Judging is conducted by a task force of the Safety & Health Council, and includes the Chair and/or Vice Chair along with representatives from first place winners of the prior year s competition, a Safety Professional of the Year, a specialty contractor representative, and a council member at large. 3. The second round of judging will be a live presentation given by the member company to a panel which includes industry experts who will then make the final decision on recipients of the Safety Award of Excellence. 4. Application procedures are developed, reviewed, and updated by a task force of the Safety & Health Council each year. 5. Completed applications are kept confidential, reviewed only by the judges. 6. Winners of AGC of California Safety Awards of Excellence are invited to apply for the AGC of America Safety Awards of Excellence program. 7. All applications must be completed and submitted according to the required format and instructions with the appropriate Entry Fee (Page 4). Applications that do not follow the required format will lose points and/or be eliminated from the competition. Any questions about the format should be directed to the AGC of California Safety Office. 1. The award is based on calendar year GENERAL RULES 2. Applicants must be a member of AGC of California in good standing for 2011 and Applicants may not have had a fatality in the year for which they are applying, or between the applications submittal and the Safety Awards Luncheon held during the AGC Fall Conference. If you have, please notify AGC of California. 4. Applications must be complete to be accepted. The application must be completely filled out and attachments included to be considered. Incomplete applications may result in point deduction or disqualification. 5. Each applicant company must have its own autonomous safety program and separately designated safety manager. Companies under the same parent company may not apply in the same category, but may apply in separate categories. 6. If qualified, members may compete in more than one category, but separate applications are required for each category. Joint Venture projects will not be considered for the Contractor Safety Excellence Award. It is intended for companies and is not project specific. JV Work Hours should not be included in the hours submitted for competing companies. JV Projects may only compete in the Safety Effort of a Project Team Category. 7. All awards are based on the member s construction activities in California only, not subsidiary or out of state operations. 8. Applications must be received in the AGC West Sacramento office no later than August 24, :00 p.m. 9. In the event that applications do not meet minimum criteria for application, judges must eliminate those applicants from the competition. Judges reserve the right not to make awards in any category in which they feel the applicants do not meet exemplary standards. 10. Because applicants may consider such information proprietary and confidential, the Safety and Health Council Judges represent that this data will be treated as such. It will be available for review solely on a need to know basis by the judges in the evaluation of the application. 11. The Signature Box must be signed by the CEO, President, or Owner of your company. Any other signature may result in point deduction or disqualification. Electronic Signatures are acceptable. 12. All photos provided with the application must be submitted electronically (USB Thumb Drive/CD Disc). Page 2

3 APPLICATION REQUIREMENTS OVERVIEW Your application must be submitted in a 1 binder, and each of the following sections must be separated by tabs. Application Parts Part I Company Info & Description of Company Part II Management Commitment/Employee Involvement Part III Description of Safety Program NOTE 1: DO NOT include your safety manual or program NOTE 2: Include electronic photos (project, applicant, award year experience) on a CD disc or USB thumb drive with your application. NOTE 3: Include the OSHA 300A form for 2010 and 2011 NOTE.4:.Include the OSHA 300 forms for 2012 Year to Date, information. Please obliterate any confidential information. NOTE 5: Include the Entry Fee Form with the application. APPLICATION INSTRUCTIONS Section Review & Instructions **Please see application for additional instructions** Part I: Part II: Part III: Company Information Form & Description of Company Section 1: Please fill in the appropriate fields under the General Information section. Section 2: Select what Category in which your company should compete. Section 3: In the Description of Company section, please provide a brief description of the last three types of jobs your company performed. Section 4: Please place your company s OSHA Logs in this section. Management Commitment/Employee Involvement Section 1-12: Please indicate by placing an X in the appropriate box as to whether or not your company includes the items in your accident prevention program. Please provide an explanation in the notes section at the end of the checklist for any NO or N/A responses. Note: Winners will not necessarily have checked Yes for all items. Description of Safety Program Section 1: Use this part as a guide to prepare the written description of your safety program. Section 2: Provide no more than two pages describing why you believe your safety program deserves to win. Applications must be prepared in a 1 tabbed binder. The binder must be prepared in the same order as the application. Please, no exceptions!! COMPLETED APPLICATIONS DUE FRIDAY, AUGUST 24, 2012 Send completed applications to: Safety & Health Council AGC of California 3095 Beacon Blvd. West Sacramento, CA No later than 5:00 p.m. on Friday, August 24, 2012 For More information, call AGC of California at (916) Page 3

4 25 th Annual Safety Awards of Excellence Application Sponsored by the Safety & Health Council Entry Form Completed Applications Due: Friday, August 24, 2012; by 5:00 p.m. To ensure that your Safety Awards of Excellence Application is successfully processed, please complete this form and submit it along with your application. The application fee is $100 which includes the Building, Heavy/Civil/Highway, and Specialty Divisions along with the High Hazard and Unique Safety Applications. There is an additional $25 application fee for the Individual Safety Effort of a Project Superintendent, Safety Effort of a Project Team, and Safety Professional of the Year application submissions. Safety Award Category Selections $ Main Entry Application: Building Heavy/Civil/Highway Specialty Contractor Safety on a High Hazard Project (Optional) Unique Safety Application (Optional) $ Individual Safety Effort of a Project Superintendent $ Safety Effort of a Project Team $ Harry Eckstein Safety Professional of the Year Associate Member Contribution to the Industry (No Fee) Please complete this form and return it to: Associated General Contractors of California, Inc. / 3095 Beacon Blvd. / West Sacramento, CA / Attn: Kasaundra Duncan / P: (916) / F: (916) or duncank@agc-ca.org. Contact Information: Name: Firm: Address: City: State: Zip: Telephone: ( ) Payment Information VISA MasterCard American Express Check Card # Expiration Date: / Amount: Signature: Name on Card: Page 4

5 25 th Annual Safety Awards of Excellence Application Sponsored by the Safety & Health Council PART I: SECTION 1: COMPANY INFORMATION This page must be complete and in front of the first tab in your application binder Has your company experienced an occupational-related fatality event involving an employee(s) of your company during 2011 or 2012? (Reference General Rules; Page 2: Section 7) YES NO Stop here! Your company is ineligible to apply for this year s award. Continue with application If your company has a fatality involving a company employee after submitting this application but prior to the Safety Awards of Excellence event in 2012, you must notify AGC of California. Your company will not be eligible for an award. GENERAL INFORMATION Company Name: Primary Contact Person: Address: Title: City: Phone: State: Fax: Zip Code: Company President/CEO Name: President/CEO Signature: Safety Director Name: Safety Director Signature: Written or electronic signatures must be provided for application to be processed. Page 5

6 SECTION 2: ENTRY CATEGORY AND INJURY ILLNESS DATA & RATES BUILDING DIVISION Under 200,000 work hours 200, ,000 work hours 500,001 1 million work hours Over 1 million work hours HEAVY/CIVIL/HIGHWAY DIVISION Under 200,000 work hours 200, ,000 work hours 500,001 1 million work hours Over 1 million work hours SPECIALTY DIVISION Under 500,000 work hours 500,001 1 million work hours Over 1 million work hours 1. Average Number of Employees 2. % of Self-Performed Hours Worked 3. Total Employee-Hours Worked 4. Total Number of Lost Work-Day Cases Injuries/Illnesses (Total in Column H of the OSHA 300 Log) 5. Total Restricted Work-Day cases (see formula below) 6. Lost Work-Day Incidence Rate (see formula below) 7. Total Recordable Injury/Illnesses (Totals in Columns H, I & J of the OSHA 300 Log) 8. Recordable Incidence Rate (see formula below) 9. DART Rate (see formula below) Calendar Year 2010 Calendar Year 2011 Calendar Year (YTD) July 2012 The formula for either the Lost Work-Day or Recordable Incident rate is: # of (Lost Work-Day Cases or Total Recordable Cases) x 200,000 Total Employee-Hours Worked The formula for DART rate is: # of (Lost Work-Day Cases plus Total Restricted Work-Day Cases) x 200,000 Total Employee-Hours Worked Page 6

7 SECTION 3: ENTRY CATEGORY Provide a brief description of the last three types of jobs your company performed. No more than one-half page description for all three jobs. NOTE: To ensure compliance to length of each narration portion below, any deviation from parameters set forth may result in disqualification. Page 7

8 PART II: SECTION 1: PRINCIPAL COMMITMENT ALL INFORMATION WILL REMAIN CONFIDENTIAL Please indicate by placing an X in the appropriate box as to whether or not your company includes the following items in your accident prevention program. There may be items in Part II (checklist) that do not apply to your company. If so, the N/A response would be appropriate (For example, a floor tile subcontractor may not have any need for trenching & excavation safety components. Therefore, N/A would be the appropriate selection.) Please provide an explanation in the notes section at the end of the checklist for any NO or N/A responses. Yes No N/A Written Safety & Health Policy signed by company principal with an emphasis on company commitment to Safety & Health Designated Safety Administrator/Coordinator trained in Safety & Health hazard recognition and management/risk control Consider safety and health issues as an overriding factor during construction Company policy gives field employees authority to shut down a job or operation because of a hazard that presents an eminent danger to employees Have an annual safety and health budget, and budget(s) for each job. Funds available to support the safety program on company-wide and project-specific basis Have safety and health policy or requirements written into contracts to require subcontractors to meet your safety requirements Utilize a pre-qualification safety and health screening method to select subcontractors, suppliers or vendors Require a site specific orientation for all subcontractor, vendor, support personnel prior to project access Control and monitor all safety activities on jobsites Provide contractual provisions for termination of contractors for unsatisfactory safety performance Company publishes regular safety newsletter or other regular safety communication NOTES: Page 8

9 SECTION 2: ACCIDENT PREVENTION PLAN & PROCEDURES Mark the appropriate box next to each item. Check one column for each row. If an element does not apply, mark N/A. Yes No N/A New-Hire Orientation Provide safety and health rules that are equal to OSHA standards Provide safety and health rules that exceed OSHA standards Required Job Hazard Analysis (JHA) Job-specific tasks Company-wide Hazard Communication coordinator A Job-specific Hazard Communication coordinator Standard procedure to inform and receive information from other contractors on the same jobsite How to report injuries and unsafe conditions and work practices An overview of the company s safety and health requirements Location of first-aid kits/facilities Use and care of Personal Protective Equipment (PPE) Actions to take in the event of emergencies Overviews of the company s discipline procedures and enforcement policy Company s roles and responsibilities in the safety program Employee Training and Documentation that includes: Have personnel on each job trained in first-aid CPR Supervisors with OSHA extensive (i.e. 10/30-hr) hazard recognition/competent person training certification Fall Protection Systems Forklift operator training certification and evaluation Competent person safety training applicable for your business (i.e., Scaffolds, trenching and excavations, etc.) Fire Prevention Hazard Communication Defensive Driving Use of Personal Protective Equipment (PPE) and Respirators Confined Space Hazards Asbestos Hazard Awareness Lead Hazard Awareness Silica Dust Hazard Awareness Manual Lifting Hazard Awareness Page 9

10 SECTION 2: ACCIDENT PREVENTION PLAN & PROCEDURES (CONTINUED) Mark the appropriate box next to each item. Check one column for each row. If an element does not apply, mark N/A. Yes No N/A Electrical Hazards, including Lockout/Tagout procedures Site-specific risks and hazard awareness Traffic Zone Hazard Awareness and Flagging Permit Procedures and Tracking Provide Safety Training in a language other than English Provide written material and signs in language other than English A Written Policy or Procedure that includes: Fall Protection Plan Blood borne Pathogens Exposure Control Plan Heat Illness Prevention Program Fire Prevention and Emergency Action Plan Asbestos and Lead Procedures Trenching and Excavation Procedures Traffic Control Plan Vehicle Driver Selection and Fleet Safety Policy Assured Equipment Grounding or GFCI Program Disciplinary Procedures and Enforcement of Subcontractor Safety Workplace Violence and Harassment policy Explosives and Detonation Safety Plan Pre-lift cranes or hoisting equipment plan Behavior-based observations and reporting Lockout/Tagout of hazardous energy sources Quality Assurance/Quality Control Plan Demolition Plan Muscle Strain Prevention Program Root Cause Analysis on All Incidents Permit-Required Confined Space Entry Procedures Hazardous Communication Program Written Cell Phone Policy Code of Safe Practices Safety Performance Recognition Program Page 10

11 NOTES: Page 11

12 SECTION 3: DESIGNATED SAFETY COORDINATOR/MANAGER/COMMITTEE Mark the appropriate box next to each item. Check one column for each row. If an element does not apply, mark N/A. Yes No N/A Safety responsibilities clearly defined in writing Reports to executive management or executive committee Attends management and project safety meetings Safety Professional is member of AGC of California Safety & Health Council Safety Professional is member of American Society of Safety Engineers or other professional safety organizations Has degree or professional certificates in safety and health Conducts and records safety inspections Conducts and records accident investigations Crisis Management Training Diversity Training Leadership Training Makes decisions on Safety Procedures and Policies NOTES: Page 12

13 SECTION 4: EMERGENCY PROCEDURES AND FIRST AID/CPR Mark the appropriate box next to each item. Check one column for each row. If an element does not apply, mark N/A. Yes No N/A First aid and CPR Certifications (Current and Up-to-Date) Written emergency procedure plan for evacuation Crisis Management Plan Have the appropriate/adequate first-aid supplies and equipment on a jobsite Have an emergency rescue plan in place for a fall and caught-in-between victim (i.e. falls, excavations, confined space, etc) SECTION 5: INSPECTIONS, ACCIDENT INVESTIGATIONS, AND REPORTS Yes No N/A Maintain safety and health recordkeeping requirements Provide safety inspection and accident investigation procedures Injury accidents are investigated promptly after an occurrence and a report is presented Accident reports are reviewed regularly to determine corrections Require safety and health inspections of each jobsite at least weekly by the supervisor Safety and health issues are discussed and addressed at each job progress meeting with the other contractors Require safety and health inspections of each jobsite by the company safety director or project manager at least monthly An investigation procedure in place for near misses Daily site inspections conducted by competent person Site inspections documented NOTES: Page 13

14 SECTION 6: CONSISTEN USE OF SAFETY POSTERS AND POSTED INFORMATION Mark the appropriate box next to each item. Check one column for each row. If an element does not apply, mark N/A. Yes No N/A All required Federal and State forms and notices posted at jobsite Post Injury and Illness records such as 300A form Communicate all environmental monitoring and test data with employees (i.e. post the results of air tests) Use warning signs on jobsites to alert workers to hazards Safe Practices and rules posted Crane or material handling hand signals posted SECTION 7: SUBSTANCE ABUSE POLICY PROCEDURES Yes No N/A Written Drug and Alcohol Prohibition policy Drug Testing Protocol Alcohol Testing Protocol Employee Assistance Program or Counseling Referral Program Inclusion of Subcontractors in testing policy NOTES: Page 14

15 SECTION 8: SITE-SPECIFIC SAFETY PLANS Mark the appropriate box next to each item. Check one column for each row. If an element does not apply, mark N/A. Yes No N/A Documented Pre-planning process/lists Weekly Safety Meetings (Tool Box Safety Discussions) Jobsites, offices, shops, and yards are inspected at least weekly by supervisors Daily Weekly Other Documented (check all that apply) Written site-specific plans (fall protection, confined space, etc.) SECTION 9: PARTICIPATION IN AT LEAST ONE CONSTRUCTION SAFETY ACTIVITY BY ONE OR MORE EMPLOYEES This section would include all safety and occupational health related seminars, workshops and conferences. Yes No N/A Participate in Cal/OSHA, Cal/SHARP Program or VPPC Construction related association training class Active participation in a construction related association Safety Committee (specify organization in NOTES section below) Academia sponsored safety seminar/conference (i.e. college, university, or junior college) Local or regional safety seminars NOTES: Page 15

16 SECTION 10: RETURN-TO-WORK PROGRAM AND MEDICAL MANAGEMENT Mark the appropriate box next to each item. Check one column for each row. If an element does not apply, mark N/A. Yes No N/A Written Return-to-Work (RTW) program Written Modified Duty tasks or descriptions Coordination with physicians/modified duty descriptions Documentation of supervisory training in RTW criteria Written claims management policy and procedure SECTION 11: SUBCONTRACTOR MANAGEMENT Yes No N/A Subcontractor/Contractor Liaison policy Every worker, including subcontractor employees, completes safety orientation for each project At least monthly manager/supervisor/project management safety meetings Subcontractors submit site-safety plans Sanctions applied for subcontractor non-compliance with safety standards Safety and health policy requirements written into contracts to compel subcontractors to meet your safety requirements Pre-qualification of subcontractors includes safety Preconstruction safety meetings conducted with subcontractors NOTES: Page 16

17 SECTION 12: GENERAL CONTRACTORS/CONTRACT MANAGERS Mark the appropriate box next to each item. Check one column for each row. If an element does not apply, mark N/A. Yes No N/A Provide OSHA 10 hour training to field employees Provide 30 hour OSHA training to field management staff Track subcontractor work hours by site or project Track subcontractor related injuries by site or project Have a mandatory 100% -6 foot fall protection requirement for all trades OR adhere to the Cal/OSHA ran program Does your company participate in any OSHA partnerships or alliances Do you offer your subcontractors free OSHA 10 or 30 hour training Do you utilize Cal/OSHA Consultation services Require JSA (Job Safety Analysis) use by subcontractors for daily operations Require daily written crane inspections Require crane pre-task planning for all picks Require 3 rd party crane inspections prior to crane operational start up Do you conduct daily pre-task meetings with involved trades covering high hazard work Do you conduct a project-wide muscle strain prevention program NOTES: Page 17

18 PART III: SECTION 1: DESCRIPTION OF SAFETY PROGRAM Provide no more than two pages (12 font, Times New Roman, with at least 1 inch margins) describing your safety program and your commitment to safety and health with an overview of its implementation, addressing all the criteria that applies. Use this part as a guide to prepare the written description (qualitative description) of your safety program. Please include information about your orientation program, training program, recognition program, innovative practices and those elements described in the following table. Participant Involvement: Consider how the individuals closest to the daily work make decisions that improve safety. Please write about how your project managers/superintendents ensure that everyone is able to participate in the decision making process when it comes to safety. Open discussion: Consider how your project managers/superintendents ensure that there are open discussions about safety how they communicate their expectations. Please write about a time when your project managers/superintendents made safety a priority in order to push a key project forward. Visible Management Commitment: Consider how your project managers/superintendents perform their daily site activities. Please write about a time when you had to communicate safety expectations to your customer while handling a number of competing priorities like schedule and quality. Page 18

19 Page 19

20 Page 20

21 SECTION 2: WHY YOU DESERVE TO WIN Provide no more than two pages (12 font, Times New Roman, with at least 1 inch margins) describing your safety program and your commitment to safety and health with an overview of its implementation, addressing all the criteria that applies. Be creative. This is your opportunity to demonstrate that special something that sets you apart from the others your core competency in safety. Explain the things that you feel you do better than everyone else. Judges will be evaluating the following: Overview of company safety program High level of employee involvement in safety New programs, procedures or resources used by company to promote safety Management s involvement/commitment to safety Unique program elements used by company to promote and heighten safety awareness. Page 21

22 Page 22

23 Page 23

24 25 th Annual Safety Awards of Excellence Application Sponsored by the Safety & Health Council Harry Eckstein Safety Professional of the Year Award Award Year 2011 Completed Applications Due: Friday, August 24, 2012; by 5:00 p.m. The safety profession is made up of men and women who have devoted their careers making our workplaces safer. Some safety professionals go far and above the call of duty in their devotion to preserving quality of life in the workforce. Many go far above and beyond the borders of their employer, distinguishing him or her by giving back to the industry. This very prestigious award exemplifies the most dedicated and innovative professionals and their active participation in the advancement of the safety management process both within their company and in the construction industry. This is an opportunity for the safety professional to be recognized by their company senior management in nomination and by their peers in achieving this award. General Rules 1. The company CEO or president must nominate candidates for this award. 2. A nominee for this award must devote at least 50% of his or her duties to Safety and Health. 3. Candidate s duties must be performed for California operations for a member company and a member company must employ the candidate at the time of nomination and award. The member company must be in good standing for 2011 and Eligible candidates may not have received this award in the past five years. 5. All application or nomination packages for award must be complete and submitted in a tabbed binder, with the following sections: General Information Form in front of the first tab Section One Narrative and optional photographs or illustrations Section Two - Application/Questionnaire Responses Section Three - Attachments 6. Submit $25.00 Application Fee. Send completed applications to: Safety & Health Council AGC of California 3095 Beacon Blvd. West Sacramento, CA No later than 5:00 p.m. on Friday, August 24th, For more information, call AGC of California at (916) Page 24

25 Harry Eckstein Safety Professional of the Year Application Sponsored by the Safety & Health Council This page must be complete and in front of the first tab in your application binder Has your company experienced an occupational-related fatality event involving an employee(s) of your company during 2011 or 2012? (Reference General Rules; Page 2: Section 7) YES NO Stop here! Your company is ineligible to apply for this year s award. Continue with application If your company has a fatality involving a company employee after submitting this application but prior to the Safety Awards of Excellence event in 2012, you must notify AGC of California. Your company will not be eligible for an award. GENERAL INFORMATION Company Name: Primary Contact Person: Address: Title: City: Phone: State: Fax: Zip Code: Company President/CEO Name: President/CEO Signature: Safety Director Name: Safety Director Signature: Written or electronic signatures must be provided for application to be processed. Page 25

26 SECTION 1: NARRATIVE Please provide a short essay (one to two pages) describing the candidate s background and accomplishments and why this candidate is deserving of the Harry Eckstein Safety Professional of the Year award. Take this opportunity to draw the judges attention to their specific accomplishments and contribution to the industry as well as to the company. In the event that your Safety Professional is a winner, we may use this information in the presentation of their award. You may include photographs or illustrations in this section, behind the narrative page. Include information about specific characteristics or accomplishments that demonstrate that special something that sets this candidate apart from others. Important qualities of a deserving candidate include evidence of contribution to the industry as a safety professional, development of a safety culture with a high level of employee involvement and management commitment, continuous improvement, and new and/or unique programs developed by the candidate. SECTION 2: APPLICATION QUESTIONNAIRE 1. Description of safety and health duties. Include percentage of time devoted to safety and health duties. 2. Length of time as a Safety Professional, include history covering past 10 years or more. You may provide a resume for this element or a description. 3. Education and training, completed or in process. 4. Participation in professional safety related organizations, seminars or activities. 5. Brief overview of the company s safety program and nominee s involvement in its creation and implementation. Include highlights of exemplary accomplishments. 6. New programs developed and implemented by nominee. 7. Nominee improvements in company s safety record or programs under nominee s leadership. 8. Leadership traits that have contributed to nominee s success as Safety Director, illustrate with example(s). 9. Special professional accomplishments in construction safety and contributions to the construction industry (include publications, presentations, memberships, speeches, etc). SECTION 3: ATTACHMENTS 1. OSHA 300 log 2011 & YTD (Please DO NOT display any confidential information) 2. Verified Experience Modification for past two (2) years. 3. Company Safety Program/IIPP table of contents. 4. Self - insurance certificate, if self insured. Page 26

27 25 th Annual Safety Awards of Excellence Application Sponsored by the Safety & Health Council Special Safety Award Completed Applications Due: Friday, August 24, 2012; by 5:00 p.m. In addition to the Safety Awards of Excellence for a company s overall safety performance, there are four special award categories. The judges may elect to grant no more than three awards in each category. Each award requires a separate application. Special Safety Award Categories HIGH HAZARD PROJECT AWARD UNIQUE SAFETY APPLICATION INDIVIDUAL SAFETY EFFORT OF A PROJECT SUPERINTENDENT SAFETY EFFORT OF A PROJECT TEAM ASSOCIATE MEMBER CONTRIBUTION TO INDUSTRY SAFETY Application Submission Submit applications to: Safety and Health Council AGC of California 3095 Beacon Blvd. West Sacramento, CA General Information 1. Direct your questions about the awards program or about your application to the AGC of California Safety Office at (916) and/or Kate Smiley, Safety Manager at smileyk@agc-ca.org. 2. Judging is conducted by a panel and includes the Chair and Vice Chair of the Safety and Health Council along with representatives from first place winners of the prior year s competition, a Safety Professional of the Year, a specialty contractor representative and a council member at large. 3. Finalists are judged in a second round which may include industry experts. 4. Award procedures are updated annually by representatives from the Safety & Health Council. 5. Completed applications are kept confidential, reviewed only by the judges. 6. All applications must be completed and submitted according to the required format and instructions. Applications that do not follow the required format will lose points or be eliminated. 7. The award is based on calendar year Applicant must be a member of AGC of California in good standing for 2011 and Applicants may not have had a fatality in the year for which they are applying or between the application submittal and the awards event in If qualified, members may compete in more than one category, but separate applications are required for each category. 11. Each applicant company must have its own autonomous safety program and separately designated safety manager. Companies under the same parent company may not apply in the same category. 12. All awards are based on the member s construction activities in California only, not subsidiary or out of state operations. 13. Judges reserve the right not to make awards in any category in which they feel the applicants do not meet exemplary standards. 14. Electronic photos of your project should be included with your application on a CD disc or USB thumb drive. Page 27

28 Safety Excellence on an Individual High Hazard Job Application Completed Applications Due: Friday, August 24, 2012; by 5:00 p.m. This page must be complete and in front of the first tab in your application binder Has your company experienced an occupational-related fatality event involving an employee(s) of your company during 2011 or 2012? (Reference General Rules; Page 2: Section 7) YES NO Stop here! Your company is ineligible to apply for this year s award. Continue with application If your company has a fatality involving a company employee after submitting this application but prior to the Safety Awards of Excellence event in 2012, you must notify AGC of California. Your company will not be eligible for an award. COMPANY INFORMATION Name of Safety Application or Project: Company Name: Primary Contact Person: Address: Title: City: Phone: State: Fax: Zip Code: Company President/CEO Name: President/CEO Signature: Safety Director Name: Safety Director Signature: Written or electronic signatures must be provided for application to be processed. Page 28

29 Award Requirements The job must be considered high hazard. For example, a multi-story structure over 36 feet, work occurs in engineered trenches, or where significant danger of serious injury or death can occur. There must be no lost time injuries on the project. Application 1. Narrative description. Describe the job and what characterizes it as high hazard. 2. Submit injury and illness record for the project. 3. Identify the project, and duration of the project. Include number of worker hours. 4. Provide a job hazard analysis that includes a description of the hazardous activities and preventative measures implemented. 5. Submission of electronic photos is required with your application. Page 29

30 Unique Safety Application Completed Applications Due: Friday, August 24, 2012; by 5:00 p.m. This page must be complete and in front of the first tab in your application binder Has your company experienced an occupational-related fatality event involving an employee(s) of your company during 2011 or 2012? (Reference General Rules; Page 2: Section 7) YES NO Stop here! Your company is ineligible to apply for this year s award. Continue with application If your company has a fatality involving a company employee after submitting this application but prior to the Safety Awards of Excellence event in 2012, you must notify AGC of California. Your company will not be eligible for an award. COMPANY INFORMATION Superintendent/Manager Name: Company Name: Primary Contact Person: Address: Title: City: Phone: State: Fax: Zip Code: Company President/CEO Name: President/CEO Signature: Safety Director Name: Safety Director Signature: Written or electronic signatures must be provided for application to be processed. Page 30

31 Award Requirements This award recognizes companies that have designed a unique or creative system or systems to address a safety hazard and/or provides employee safety in unusual situations. Application 1. Narrative description. Describe the safety challenge and the unique system developed to address it. Explain the benefits of the application 2. Identify the project. 3. Submission of electronic photos or illustrations/drawings is required with your application. Page 31

32 Individual Safety Effort of a Project Superintendent Application Completed Applications Due: Friday, August 24, 2012; by 5:00 p.m. This page must be complete and in front of the first tab in your application binder. Has your company experienced an occupational-related fatality event involving an employee(s) of your company during 2011 or 2012? (Reference General Rules; Page 2: Section 7) YES NO Stop here! Your company is ineligible to apply for this year s award. Continue with application If your company has a fatality involving a company employee after submitting this application but prior to the Safety Awards of Excellence event in 2012, you must notify AGC of California. Your company will not be eligible for an award. Superintendent/Manager Name: COMPANY INFORMATION Company Name: Primary Contact Person: Address: Title: City: Phone: State: Fax: Zip Code: Company President/CEO Name: President/CEO Signature: Safety Director Name: Safety Director Signature: Written or electronic signatures must be provided for application to be processed. Page 32

33 Award Requirements This award is designed to recognize a company Superintendent or Manager whose job is not primarily safety related, but rather jobsite management. The company CEO/President must nominate an individual for this award. The duties must be performed for California operations for a member company. In order to qualify, the nominee has to have displayed positive efforts in safety, improvement in safety performance and involved others in their commitment to safety on the job. Application 1. Submit evidence or description of safety and/or incident record for projects under the supervision of nominee. No willful CAL/OSHA citations under the candidate s supervision. 2. Describe how this individual has displayed commitment to safety and health and involved others in that commitment on projects. 3. Describe other contributions nominee has made to the safety of the jobsite or the company. 4. Submission of electronic photos is recommended but not required and should be included on your application. 5. Please submit a maximum of a two-page summary supporting why your candidate should be considered for this award. You must include, but are not limited to the following: Safety Leadership (i.e. project recognition programs, discipline programs, orientation program, etc.) Description of candidate s effective safety practices. Safety Training that is project specific. Safety Certifications and/or Awards. Describe the type of supervision activities, to include subcontractor activities. 6. Submit $25.00 Application Fee. Page 33

34 Safety Effort of a Project Team Application Completed Applications Due: Friday, August 24, 2012; by 5:00 p.m. This page must be complete and in front of the first tab in your application binder. Has your company experienced an occupational-related fatality event involving an employee(s) of your company during 2011 or 2012? (Reference General Rules; Page 2: Section 7) YES NO Stop here! Your company is ineligible to apply for this year s award. Continue with application If your company has a fatality involving a company employee after submitting this application but prior to the Safety Awards of Excellence event in 2012, you must notify AGC of California. Your company will not be eligible for an award. Superintendent/Manager Name: COMPANY INFORMATION Company Name: Primary Contact Person: Address: Title: City: Phone: State: Fax: Zip Code: Company President/CEO Name: President/CEO Signature: Safety Director Name: Safety Director Signature: Written or electronic signatures must be provided for application to be processed. Page 34

35 Award Requirements This award is designed to recognize a company Project Team whose job is not primarily safety related, but rather jobsite management. The company CEO/President must nominate a group for this award. The duties must be performed for California operations for a member company. In order to qualify, the nominees must have displayed positive efforts in safety, improvement in safety performance, and involved others in their commitment to safety on the job. Teams on a Joint Venture Project may be nominated for this award. Application 1. Submit evidence or description of safety and/or incident record for projects under the supervision of the project team. No willful CAL/OSHA citations under the team s supervision. 2. Describe the team s commitment to safety and health, and were others involved in that commitment on projects. 3. Describe other contributions made to the safety of the jobsite or the company. 4. Submission of electronic photos is recommended but not required and should be included on your application. 5. Please submit a maximum of a two-page summary supporting why this project team should be considered for this award. You must include, but are not limited to the following: Safety Leadership (i.e. project recognition programs, discipline programs, orientation program, etc.) Description of effective safety practices. Safety Training that is project specific. Safety Certifications and/or Awards. Describe the type of supervision activities, to include subcontractor activities. 6. Submit $25.00 Application Fee. Page 35

36 Associate Member Contribution to Industry Safety Application Completed Applications Due: Friday, August 24, 2012; by 5:00 p.m. This page must be complete and in front of the first tab in your application binder Has your company experienced an occupational-related fatality event involving an employee(s) of your company during 2011 or 2012? (Reference General Rules; Page 2: Section 7) YES NO Stop here! Your company is ineligible to apply for this year s award. Continue with application If your company has a fatality involving a company employee after submitting this application but prior to the Safety Awards of Excellence event in 2012, you must notify AGC of California. Your company will not be eligible for an award. COMPANY INFORMATION Nominated by (Name and Contact Information): Associate Member Company Name: Company President/CEO Name: Address: Title: City: Phone: State: Fax: Zip Code: Nominating Signature: Written or electronic signatures must be provided for application to be processed. Page 36

37 Award Requirements Recognizing that many of our Associate members provide exemplary health and safety related service to our contractor members; the committee would like to recognize those who provide valuable support. Contractor members are invited to nominate Associate members for this award. Associate members are encouraged and invited to apply for this award as well. The award is based on service to the industry rather than the safety accomplishments within the associate member company. Application 1. Describe how the firm or individual has demonstrated commitment to construction safety and involved others in that commitment. 2. Provide examples of how the nominee has supported contractor members safety programs and/or industry safety. 3. Letters of support are encouraged. 4. Submission of electronic photos is recommended but not required and should be included on your application. Page 37