Cover Sheet: Complete all information required on the cover sheet. Include your Occupational Injury and Illness data for the most recent full calendar year from the OSHA Form 300 and 300A logs, or MSHA 7000-1 reports as applicable. Be sure to include the average number of employees and employee man-hours worked for the most recent full calendar year and your NAICS code with your injury/illness data. Attach a copy of the OSHA summary and OSHA 300 and 300A logs, or MSHA 7000-1 reports as applicable. Written Application: Provide significant details of employer’s safety and health program. Please complete all of the attached questions found in the guidelines for written application below. Limit – five (5) pages total. Include significant milestones, achievements, awards, and other pertinent information. (Optional) Supplemental Information Sheet: Limit one (1) page total. Applicant’s Statement: Print, sign, and attach the applicant’s statement page. When you’re done, your application will look like this: Page 1 Sheet, Including occupational injury and illness data Page 2-6 Written Application (5 pages maximum) Page 7 (Optional) Supplemental Information (1 page maximum) Attachments OSHA 300 and 300A logs, or MSHA 7000-1 reports as applicable (no limit) Thank you for applying for a Wyoming Safety & Workforce Summit Award!! We are proud to serve employers in our and appreciate this opportunity to recognize your great work in to improve the health and safety of our workforce! APPLICATION COVER SHEET (1 page) Business Name: Address:
Cover Sheet: Complete all information required on the cover sheet. Include your Occupational Injury and Illness data for the most recent full calendar year from the OSHA Form 300 and 300A logs, or MSHA 7000-1 reports as applicable. Be sure to include the average number of employees and employee man-hours worked for the most recent full calendar year and your NAICS code with your injury/illness data. Attach a copy of the OSHA summary and OSHA 300 and 300A logs, or MSHA 7000-1 reports as applicable. Written Application: Provide significant details of employer’s safety and health program. Please complete all of the attached questions found in the guidelines for written application – below. Limit five (5) pages total. Include significant milestones, achievements, awards, and other pertinent information. (Optional) Supplemental Information Sheet: Limit one (1) page total. Applicant’s Statement: Print, sign, and attach the applicant’s statement page. When you’re done, your application will look like this: Page 1 Sheet, Including occupational injury and illness data Page 2-6 Written Application (5 pages maximum) Page 7 (Optional) Supplemental Information (1 page maximum) Attachments OSHA 300 and 300A logs, or MSHA 7000-1 reports as applicable (no limit) Thank you for applying for a Wyoming Safety & Workforce Summit Award!! We are proud to serve employers in our and appreciate this opportunity to recognize your great work in to improve the health and safety of our workforce! APPLICATION COVER SHEET (1 page) Business Name: Address:
awards-application-oshamines.docx