2023 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. A brief description of your safety efforts: *
3. How have your safety efforts improved your workplace or your work site? *
4. Submitted SUHBA Safe Contractor checklist *

Yes No
5. What impact has the SUHBA Safety Program and Resources had on your safety program? *

Safety Award Category: *

General Contractor Trade Contractor Service Contractor Supplier Contractor
Submit your company logo: *

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