2026 Safety Award Application

1. A copy of your NCCI Experience Modification Rating. If you do not have one, please refer to the application instructions. If you are not eligible for one, please enter an e-mod rate of 1.00 here or enter your e-mod rate from your NCCI form.
Experience Modification Rate:*
2. Please give us a list of what activities you have to create safety on job sites. Give details of your safety plan:*
3. What impact has your safety program had on your company?*
4. What percentage of your budget do you use on your safety program?
5. What resources are you using to build out your safety program?
6. What are you doing to create a safety culture in your company?
7. Submitted SUHBA Safe Contractor checklist*

YesNo

If you have any employees this year, please complete questions 8-10.
8. Number of office employees:*
9. Number of construction/manual labor workers:*
10. Number of Foremen and/or Superintendents:*
11. How many accidents have you had in 5 years that have needed medical assistance beyond basic first aid, include any accidents of subcontractors on your job site(s):*
12. How many accidents have you had in 10 years that have needed medical assistance beyond basic first aid, include any accidents of subcontractors on your job site(s):*
13. How have your employees been involved in your safety program?*

Safety Award Category:*

General ContractorTrade ContractorService ContractorSupplier Contractor
Submit your company logo:*

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"SUHBA Safe Contractor"

SUHBA's goal is to raise awareness and safety culture with contractors.
Safety Pays – Making safety part of everything you do in your work area can reduce costs and improve productivity on the jobsite.
Hold everyone accountable – everyone who sets foot on the jobsite is responsible for safety.
How to qualify – submit the completed form to denise@suhba.com to qualify as a “SUHBA Safe Contractor”. We will promote safe builders and contractors in the Parade Magazine, Building Guide, SUHBA website, social media, SUHBA newsletter, and a promotional sign at SUBHA events.
Note: Where applicable please complete this form even if you are not a building contractor. Put N/A for all which are non-applicable.
Check all that apply:
Please include any pictures that demonstrate your safety efforts on your job sites:

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By completing and signing this form you are agreeing that the above items are being implemented on your jobsites.
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"SUHBA Safe Contractor"