America's Safest Companies Questionnaire

Occupational Hazards is now accepting applications for its annual America's Safest Companies recognition program. If you think your company deserves to be considered one of America's Safest Companies, please fill out this questionnaire and return it and any other pertinent materials to:

Sandy Smith, Managing Editor

Occupational Hazards

1300 E. Ninth St.

Cleveland, OH 44114-1503

Safest Companies Questionnaire

Company name:

Headquarters address:

Industry/Product(s):

Number of employees/sites:

Lost-time injury rate for your company and your industry's average:

Please name any other safety or environmental awards received by your company:

Number of EHS professionals at 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?

Please check all that apply. Does your company have:

____ safety committee(s)

____ ergonomics program

____ an incentive/motivation program

____ employee wellness program

____ a formal training/mentoring program

____safety auditing program

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 __________________________________________________________________

Title ___________________________________________________________________

Telephone and e-mail ____________________________________________________

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