2016 SAFETY INNOVATION AWARDPlease complete this application in its entirety. Failure to follow the application directions may result in rejection of your submittal. This form must be completed by Friday, January 15, 2017.
To be eligible for this award, your company must be an ACI member. Additionally, if your company has experienced a willful violation or occupational-related fatality during 2015, your company is ineligible to apply for this year’s award. Has your company experienced a willful violation or occupational-related fatality during 2015? No: Proceed with completing the following application. Yes: Stop here; your company is ineligible to apply for this year’s award. NOTE: If your company has a fatality involving a company employee after submitting this application, ACI must be notified. Your company will not be eligible for an award, and if you are a finalist, your company will be removed from the eligible candidate list. |
|
SECTION 1: General Information
Location Name
1345 Main St
San Francisco, CA
Lorem ipsum dolor sit amet, consectetur adipisicing elit, sed do eiusmod tempor incididunt ut labore et dolore magna aliqua. Ut enim ad minim veniam, quis nostrud exercitation ullamco laboris nisi.
1345 Main St
San Francisco, CA
Lorem ipsum dolor sit amet, consectetur adipisicing elit, sed do eiusmod tempor incididunt ut labore et dolore magna aliqua. Ut enim ad minim veniam, quis nostrud exercitation ullamco laboris nisi.
SECTION 2 – Injury & Illness Incidents & Frequency Rate (Calendar Year 2015)
*The formula for either rate is: # of (lost workday cases or total recordable cases) * 200,000
Total Employee-hours worked
Total Employee-hours worked
Section 3: Innovative Narrative
What innovative process, program, or device has your company, or the company that you are submitting for, developed and initiated in the past year? Be creative. This is your opportunity to demonstrate that "special something" that sets the nominated company apart from the others. Explain what sets this innovation apart from other industry best practices. What led the company to this innovation or improvement (problem)? What goals and objectives did they set forth and hope to achieve with the innovation or improvement?
Judges will evaluate the following:
- Overview of safety innovation or improvement (what is special about your innovation),
- High level of employee involvement in this safety innovation,
- New programs, procedures or resources used by your company to promote this innovation,
- Management's involvement/commitment to the safety innovation,
- Unique elements used by the company to promote and heighten safety awareness, and
- If the innovative concept has been in place for a period of time, provide before and after results.
The information in each applicant’s narrative will be used to determine the winners of ACI’s 2016 Safety Innovation Award. Please provide below a full explanation of the safety process, system and equipment that is innovative.
Judges will evaluate the following:
- Overview of safety innovation or improvement (what is special about your innovation),
- High level of employee involvement in this safety innovation,
- New programs, procedures or resources used by your company to promote this innovation,
- Management's involvement/commitment to the safety innovation,
- Unique elements used by the company to promote and heighten safety awareness, and
- If the innovative concept has been in place for a period of time, provide before and after results.
The information in each applicant’s narrative will be used to determine the winners of ACI’s 2016 Safety Innovation Award. Please provide below a full explanation of the safety process, system and equipment that is innovative.
Please include pictures and/or videos demonstrating your innovative safety ideas or include examples/samples if appropriate. You may also submit engineered drawings if your company has engineered or adopted a process to protect your employees.
The application, plus all supporting materials (including signatures, photos and/or videos and the company logo in a JPG or EPS file) must be received by Friday, January 15, 2016 for award consideration.
