Builders Exchange of Dayton Safety Program Awards

Safety Program Application

The Safety Program Awards recognize Builders Exchange of Dayton Members that have demonstrated a commitment to improving jobsite safety through development, implementation, and enforcement of a safety and risk management program.
Applicant must be a current Builders Exchange of Dayton Member Company with a documented safety/risk management program including a formal written safety program.
The information in Section 1, and any reference in any part of this application to a specific company, will not be included when the application is judged. All information provided on this application will be kept in strict confidence. The DBX reserves the right to publish any innovative safety ideas from the entries for the good of the industry. However, any company-specific information regarding accident or injury statistics, or any other information identified by the applicant as proprietary, will be kept in confidence by DBX Legal Counsel as applying to the specific company.
Applications will be judged by nationally renowned OSHA/Workers Compensation Attorney, Gary Auman, of the Legal Firm Auman, Mahan and Furry. All applicants will receive a detailed, written critique of the information provided with their application. This evaluation letter is designed specifically to facilitate ongoing safety program improvement for every participating member.
Deadline for entries is December 31, 2018. Winners will be announced at the 2019 Team Building Night event at Sinclair.
Entry Fee:
There is a $150 entry fee to have your safety plan reviewed by Legal Counsel. You can submit the payment via credit card online at the end of this application or you can choose "send payment by mail" and send in payment via check. Applications with outstanding fees will not be submitted for judging.
The $150 application fee must be paid by December 31, 2018 or the APPLICATION WILL BE DISQUALIFIED.
More Information:
Questions about clarification of application questions may be directed to Gary Auman at or by calling him at 937-223-6003.
PLEASE NOTE: Once the online application is started, it must be completed in the same session. Partial applications can not be returned to in a separate session. If session time is a concern, it is recommended that you prepare your answers in advance, and then copy and paste them into the answer fields. You can preview the questions below, and then start a separate session to complete your application later. You can also request a list of questions via email by contacting Megan Miller at
Please complete the following information about your company to apply for the DBX Safety Program Awards. Complete and accurate information will help the judges in making their determination and will likewise assist your company in receiving appropriate consideration.

Section 1: General Information

Company Information

City State Zip

Applicant Contact Information

First Name
Last Name

Section 2: Company Safety Program

Please provide an answer to each question. Please make your responses as complete as possible. All individual questions must be answered directly and specifically.
Please note the following two items:
1. Your application will be judged on the answers that you provide in this application form. If an answer is not provided for a question, then that question will be scored 0 points.
2. Please do not include anything in your answers that would indicate the identity of your company. The information that you provided in Section 1 will not be included with your application when it is judged. The name of your company will not be given to Legal Counsel when your application is reviewed.

Application Questions:

1. Do you have a Distracted Driving/Distracted Working Policy?
If you answered yes, please describe your Policy or Program:
2. When and how do you train your new employees and indoctrinate them into your safety program and expectations? Please provide a list of the topics you cover with them during this orientation.
3. Please describe your comprehensive recordkeeping program. Include a description for ALL records you maintain that are connected to safety, including injury records, training records, and disciplinary records with regard to safety program violations.
4. Please describe how you comply with the OSHA Requirement for having competent persons on each job site.
5. Do you have a safety enforcement program?
If yes, please describe it:
6. Does your company have a PPE hazard assessment, training, audit program?
If yes, please explain the program:
7. Do you have a substance abuse program?
If yes, please describe it:
8. Please describe your Emergency Action Plan including first-aid, communication, and evacuation.
Thank you for participating in the Builders Exchange of Dayton Safety Program Awards. All applications will be graded and recognition will be awarded at a platinum, gold, silver, bronze, or participant level. Each applicant will be judged anonymously and will receive a letter from Gary Auman critiquing their program. All applicants scored at the bronze, silver, gold, or platinum level will receive a certificate and recognition at the 2019 Team Building Night.
By checking the box below, you agree that everything submitted in this application is true to the best of your knowledge, and that you agree to pay the $150.00 application fee by the deadline of December 31, 2018:
  I agree
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