2018 CSIA Best Practices in Safety Recognition Program

The Central States Insulation Association's “Best Practices in Safety” Recognition Program highlights CSIA member companies in good standing that have demonstrated a commitment to improving jobsite safety through development, implementation, and enforcement of a formal safety and risk management program.
Eligibility:
Applicant must be a current Central States Insulation Association member company with a documented safety/risk management program including a formal written safety program.
Confidentiality:
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. CSIA 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 strict confidence.
Judging:
Applications will be judged by nationally renowned OSHA/Workers Compensation Attorney, Gary Auman, of the Legal Firm Auman, Mahan and Furry.
Deadline:
Deadline for entries is January 31, 2019. Winners will be announced at the CSIA Spring Conference. The 2019 Spring Conference will be held at Belterra Casino Resort in Florence, IN April 30th - May 1st.
Entry Fee:
There is a $150 entry fee to have your safety plan reviewed by CSIA Legal Counsel. In return, you will receive a detailed, written critique of the information provided with your application in addition to your award. This critique letter is designed specifically to facilitate ongoing safety program improvement for every participating member. You can submit payment online via credit card 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 January 31, 2019 or the APPLICATION WILL BE DISQUALIFIED.
More Information:
Questions about the application may be directed to Gary Auman at gwa@amfdayton.com or by calling him at 937-223-6003.

PLEASE NOTE!

This online form does not have a save function that allows you to come back to a partially completed application. We strongly advise that you construct your answers in a separate Word document that you can copy and paste from into this online application. If your application sessions exceeds 4 hours or if you are navigating multiple internet browser pages during your session, you may be at risk of losing your application. PLEASE save your answers in a separate document so that if you do experience any internet issues, you can still retrieve your answers for submittal.
Instructions:
Please complete the following information about your company. Complete and accurate information will help Legal Counsel in making a determination, and will likewise assist your company in receiving appropriate consideration.

Section 1: General Information

Applicant Contact Information

First Name
Last Name
Title
E-mail

Company Information

Company
Address
 
City State Zip
Phone
Please indicate which of the following applies to your company:
Does your Company have a formal written safety program?
What is your Experience Modification Rate (EMR):
What is your Lost Time Injury Frequency Rate (LTIFR):
What is your Total Recordable Injury Rate (TRIR):
What is your Days Away/Restricted or Transfer (DART) Rate:

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 questions will be scored 0 points.
2. Please do not include anything in your answers that would indicate the identity of your company. The name of your company will not be given when your application is reviewed.

Application Questions:

1. Do you have a Distracted Driving/Distracted Working Policy:
 
If you answered yes, please describe the policy in detail:
 
2. When and how do you train your new employees and indoctrinate them into your safety program and company expectations? Please provide a list of the topics you cover with them during this orientation and describe your orientation program. Also include information on how you continually ensure the level of safety knowledge your employees have every day.
 
3. Please describe your comprehensive recordkeeping program. Include ALL records you maintain in connection with safety including injury recordkeeping, training recordkeeping, and disciplinary recordkeeping with regard to safety program violations.
 
4. Please describe how you comply with the OSHA requirement for competent persons on each job site?
 
5. Please describe in detail your safety enforcement program?
 
6. Does your company have a PPE hazard assessment, training, and/or audit program?
 
If yes, please explain the program:
 
7. Do you have a substance abuse program?
 
If yes, please describe it:
 
8. Does your company have a formal heat and cold illness prevention program?
 
If so, please describe these programs:
 
9. Do you conduct random job site inspections and safety audits?
 
If so, who conducts these? How often are they conducted, and what do they cover?:
 
10. Does your company have an Emergency Action Plan including first-aid, communication, and evacuation?
 
If yes, how do you communicate this program to your employees in the field and how are they trained on the procedures?:
 

Bonus Questions:

The questions in this section will be used for informational purposes only, and may count as bonus points towards your overall score:
11. Do you feel you do anything innovative in your safety program - anything unique or not typical of industry standard practices? If so, please explain the practice and its benefit to your company.
 
12. What is your greatest safety risk as a Contractor and how do you mitigate that?
 
Thank you for participating in the Central States Insulation Association's Best Practices In Safety Recognition Program. 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 the Association's Legal Counsel, Gary Auman, critiquing their program. All applicants scored at the bronze, silver, gold, or platinum level will receive a certificate and recognition at the CSIA Spring Conference April 30th - May 1st at the Belterra Casino Resort in Florence, Indiana.
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 January 31, 2019:
  I agree
   - denotes required fields