Please return the completed questionnaire and any other pertinent materials by July 15 to:
Sandy Smith
Editor
Occupational Hazards
1300 E. Ninth St.
Cleveland, OH 44114-1503
Company name
Headquarters address
Industry/Product(s)
Number of employees/sites
Lost-time injury rate for your company and your industry's average
Number of EHS professionals at your company
Please name any other safety or environmental awards received by your company
Company/management philosophy regarding safety
Please offer at least one example that is indicative of management's dedication to safe production.
How are employees encouraged to participate in the safety process? (Please offer at least two examples.)
What are some of the key elements of your occupational safety and health program?
What makes these elements important to your safety process?
What role, if any, does safety play in the way your company does business?
Please check all that apply. Does your company have:
Safety committee(s)
Ergonomics program
An incentive/motivation/recognition program
Employee wellness program
A formal training/mentoring program
Safety auditing program
An intranet or other ways to communicate safety information to employees
Are there unique elements to the safety process at your company? If so, please describe those efforts here.
Can you share an example or examples of where your company's safety policies and procedures go above and beyond OSHA standards? Above ANSI voluntary standards? Above accepted industry standards?
Why does your company deserve to be named one of America's Safest Companies by Occupational Hazards magazine?
Please include any additional information here, or enclose it with the completed questionnaire.
Name and title of person submitting the form:
Name and title - if different - of person who should be contacted for further information:
Telephone and e-mail:
