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28th Annual Construction Safety Excellence Awards Sponsored by the Safety & Health Council

Don’t miss out on your opportunity to earn one of the prestigious Construction Safety Excellence Awards! If you are a first time applicant, contact the AGC of California Safety Office for assistance in completing your application.The AGC of California Construction Safety Excellence Awards recognizes contractors for their outstanding safety programs in the following categories:

Contractor Safety Excellence Awards are based on three categories of worker hours in Californiao Building

Under 200,000 worker hours 200,000 - 500,000 worker hours 500,001 - 1 million worker hours Over 1 million worker hours

o Heavy/Civil/Highway Under 200,000 worker hours 200,001 - 500,000 worker hours 500,001 - 1 million worker hours Over 1 million worker hours

o Specialty Contractor Under 500,000 worker hours 500,001 - 1 million worker hours Over 1 million worker hours

Harry Eckstein Safety Professional of the Year Associate Member Contribution to the Industry Individual Safety Effort of a Project Superintendent Safety Effort of a Project Team Safety on a High Hazard Project Unique Safety Application

The award application package is available online on the AGC Safety and Health CSEA Awards Page, or by calling AGC of California at (916) 371-2422 starting June 1, 2015. The application is available in PDF and Word formats. Completed applications are due by July 17, 2015.

All applications are to be submitted electronically via email to: [email protected].

The preliminary round of judging will be at the AGC of California West Sacramento Office for Northern California judges and the AGC of California West Covina Office for Southern California judges on July 23, 2015. The final judging will be live company presentations held on August 27, 2015 at the Sheraton Grand in Sacramento. The awards luncheon will be held during the 2015 AGC Annual Conference, October 22 – October 24, 2015 at the Omni Rancho Las Palmas Resort & Spa in Rancho Mirage.

AGC of California Construction Safety Excellence Awards Application

mailto:[email protected]

http://www.agc-ca.org/about.aspx?id=62

GENERAL INFORMATION1. Direct your questions about the awards program or about your application to the AGC of California

Safety Office at (916) 371-2422.2. Judging is conducted by a task force of the Safety & Health Council, and includes the Chair and/or Vice

Chair along with representatives from first place winners of the prior year’s competition, a Safety Professional of the Year, a specialty contractor representative, and a council member at large.

3. The second round of judging will be a live presentation given by the member company to a panel which includes industry experts who will then make the final decision on the Construction Safety Excellence Award recipients.

4. Application procedures are developed, reviewed, and updated by a task force of the Safety & Health Council each year.

5. Completed applications are kept confidential, reviewed only by the judges. 6. Winners of AGC of California Construction Safety Excellence Awards are nominated by the AGC of

California Chapter for the AGC of America Construction Safety Excellence Awards program.7. All applications must be completed and submitted according to the required format and instructions

with the appropriate Entry Fee (Page 4). Applications that do not follow the required format will lose points and/or be eliminated from the competition. Any questions about the format should be directed to the AGC of California Safety Office.

GENERAL RULES1. The award is based on calendar year 2014.2. Applicants must be a member of AGC of California in good standing for 2014 and 2015.3. Applicants may not have had a fatality in the year for which they are applying, or between the

applications submittal and the Safety Awards Luncheon held during the AGC Fall Conference. If you have, please notify AGC of California.

4. Applications must be complete to be accepted. The application must be completely filled out and attachments included to be considered. Incomplete applications may result in point deduction or disqualification.

5. Each applicant company must have its own autonomous safety program and separately designated safety manager. Companies under the same parent company may not apply in the same category, but may apply in separate categories.

6. If qualified, members may compete in more than one category, but separate applications are required for each category. Joint Venture projects will not be considered for the Construction Safety Excellence Award. It is intended for companies and is not project specific. JV Work Hours should not be included in the hours submitted for competing companies. JV Projects may only compete in the Safety Effort of a Project Team Category.

7. All awards are based on the member’s construction activities in California only, not subsidiary or out of state operations.

8. Applications must be received in the AGC West Sacramento office no later than July 17, 2015. 5:00 p.m. 9. In the event that applications do not meet minimum criteria for application, judges must eliminate

those applicants from the competition. Judges reserve the right not to make awards in any category in which they feel the applicants do not meet exemplary standards.

10. Because applicants may consider such information proprietary and confidential, the Safety and Health Council Judges represent that this data will be treated as such. It will be available for review solely on a need to know basis by the judges in the evaluation of the application.

11. The Signature Box must be signed by the CEO, President, or Owner of your company. Any other signature may result in point deduction or disqualification. Electronic Signatures are acceptable.

12. Electronic photos of your project should be included and submitted with your application via email. Application file size must not exceed 5 MB.


APPLICATION REQUIREMENTS OVERVIEWAll applications are to be submitted electronically via email to: [email protected] Parts

Part I – Company Info & Description of Company Part II – Management Commitment/Employee Involvement Part III – Description of Safety Program

NOTE 1: DO NOT include your safety manual or programNOTE 2: Include electronic photos and submit via email with your application. NOTE 3: Include the OSHA 300A form for 2013 and 2014. Each form must have a company

executive signature to be valid.

NOTE.4: Include the OSHA 300 forms for 2015 Year to Date, information. The form must have a company executive signature to be valid. Please obliterate any confidential information.

NOTE 5: Include the Entry Fee Form with the application.

APPLICATION INSTRUCTIONSSection Review & Instructions **Please see application for additional instructions**

Part I: Company Information Form & Description of CompanySection 1: Please fill in the appropriate fields under the ‘General Information’ section.Section 2: Select what Category in which your company should compete.Section 3: In the ‘Description of Company’ section, please provide a brief description of

the last three types of jobs your company performed.Section 4: Please attach your company’s OSHA Logs for this section.

Part II: Management Commitment/Employee InvolvementSection 1-12: Please indicate by placing an “X” in the appropriate box as to whether or not

your company includes the items in your accident prevention program. Please provide an explanation in the notes section at the end of the checklist for any NO or N/A responses. Note: Winners will not necessarily have checked “Yes” for all items.

Part III: Description of Safety ProgramSection 1: Use this part as a guide to prepare the written description of your safety program.Section 2: Provide no more than two pages describing why you believe your safety

program deserves to win.

Part IV: OSHA 300 LogsSection 1: Add OSHA 300 Logs either by submitting as a separate attachment or insert

into main application document.

COMPLETED APPLICATIONS DUEFRIDAY, JULY 17, 2015, 5:00 PM

Submit completed applications to: [email protected]

For More information, call AGC of California at (916) 371-2422




28th Annual Construction Safety Excellence Awards ApplicationSponsored by the Safety & Health Council

Entry FormCompleted Applications Due: Friday, July 17, 2015; by 5:00 p.m.

To ensure that your Construction Safety Excellence Awards Application is successfully processed, please complete this form and submit it along with your application. The application fee is $200 which includes the Building, Heavy/Civil/Highway, and Specialty Divisions along with the High Hazard and Unique Safety Applications. There is an additional $50 application fee for the Individual Safety Effort of a Project Superintendent, Safety Effort of a Project Team, and Safety Professional of the Year application submissions. PLEASE NOTE: The $50 application fee also applies to the Unique Safety and High Hazard categories if you have chosen not to participate in the Main CSEA award category.

Safety Award Category Selections $200.00 - Main Entry Application:

Building Heavy/Civil/Highway Specialty Contractor

Safety on a High Hazard Project (Optional)Unique Safety Application (Optional)

$50.00 - Individual Safety Effort of a Project Superintendent $50.00 - Safety Effort of a Project Team $50.00 - Harry Eckstein Safety Professional of the Year $00.00 - Associate Member Contribution to the Industry (No Fee)


Please complete this form and return it to: Associated General Contractors of California, Inc. / 3095 Beacon Blvd. / West Sacramento, CA 95691 / Attn: Kasaundra Duncan / P: (916) 371-2422 / F: (916) 371-2352 or E-mail: [email protected] | [email protected].

Contact Information:Name: __________________________________________ Firm: _____________________________________ Address: ________________________________________ City: _________________ State: ____ Zip: ________Telephone: ( ) ______________________________ Email: ____________________________________

Payment Information

VISA MasterCard American Express Check

Card # ___________________________________ Expiration Date: ______/_____ Amount: ___________Signature: ________________________________ Name on Card: ________________________________



28th Annual Construction Safety Excellence Awards ApplicationSponsored by the Safety & Health Council

PART I:

SECTION 1: COMPANY INFORMATIONThis page must be completed and placed at the start of your application

Has your company experienced an occupational-related fatality event involving an employee(s) of your company during 2014 or 2015? (Reference General Rules; Page 2: Section 7)

YES Stop here! Your company is ineligible to apply for this year’s award. NO Continue with application

If your company has a fatality involving a company employee after submitting this application but prior to the Safety Awards event in 2015, you must notify AGC of California. Your company will not be eligible for an award.

GENERAL INFORMATION

Company Name: Company President/CEO Name:

Address: Company President/CEO Email:

City: Company President/CEO Signature:

State: Safety Director Name:

Zip Code: Safety Director Email:

Phone: Safety Director Signature:

Fax: Primary Contact Person Name/Title:

AGC of California Company ID Number: Primary Contact Person Email:

PLEASE NOTE: Written or electronic signatures must be provided for application to be processed.


SECTION 2: ENTRY CATEGORY AND INJURY ILLNESS DATA & RATES

BUILDING DIVISION Under 200,000 work hours 200,001 – 500,000 work hours 500,001 – 1 million work hours Over 1 million work hours

HEAVY/CIVIL/HIGHWAY DIVISION Under 200,000 work hours 200,001 – 500,000 work hours 500,001 – 1 million work hours Over 1 million work hours

SPECIALTY DIVISION Under 500,000 work hours 500,001 – 1 million work hours Over 1 million work hours

Calendar Year2013

Calendar Year2014

Calendar Year (YTD)July 2015

1. Average Number of Employees2. % of Self-Performed Hours Worked3. Total Employee-Hours Worked4. Total Number of Lost Work-Day Cases Injuries/Illnesses(Total in Column H of the OSHA 300 Log)5. Total Restricted Work-Day cases (see formula below)6. Lost Work-Day Incidence Rate (see formula below)7. Total Recordable Injury/Illnesses(Totals in Columns H, I & J of the OSHA 300 Log)8. Recordable Incidence Rate (see formula below)9. DART Rate (see formula below)

The formula for either the Lost Work-Day or Recordable Incident rate is: # of (Lost Work-Day Cases or Total Recordable Cases) x 200,000Total Employee-Hours WorkedThe formula for DART rate is: # of (Lost Work-Day Cases plus Total Restricted Work-Day Cases) x 200,000Total Employee-Hours Worked


SECTION 3: ENTRY CATEGORY

Provide a brief description of the last three types of jobs your company performed. Each job description is limited to half a page including project photo. Project description and image may be inserted into the boxes below.

NOTE: To ensure compliance to length of each narration portion below, any deviation from parameters set forth may result in disqualification.


PART II:

SECTION 1: PRINCIPAL COMMITMENTALL INFORMATION WILL REMAIN CONFIDENTIAL

Please indicate by placing an “X” in the appropriate box as to whether or not your company includes the following items in your accident prevention program. There may be items in Part II (checklist) that do not apply to your company. If so, the N/A response would be appropriate (For example, a floor tile subcontractor may not have any need for trenching & excavation safety components. Therefore, N/A would be the appropriate selection.) Please provide an explanation in the notes section at the end of the checklist for any NO or N/A responses.

Yes No N/AWritten Safety & Health Policy signed by company principal with an emphasis on company commitment to Safety & HealthDesignated Safety Administrator/Coordinator trained in Safety & Health hazard recognition and management/risk controlConsider safety and health issues as an overriding factor during constructionCompany policy gives field employees authority to “shut down” a job or operation because of a hazard that presents an eminent danger to employeesHave an annual safety and health budget, and budget(s) for each job. Funds available to support the safety program on company-wide and project-specific basisHave safety and health policy or requirements written into contracts to require subcontractors to meet your safety requirementsUtilize a pre-qualification safety and health screening method to select subcontractors, suppliers or vendorsRequire a site specific orientation for all subcontractor, vendor, support personnel prior to project accessControl and monitor all safety activities on jobsitesProvide contractual provisions for termination of contractors for unsatisfactory safety performanceCompany publishes regular safety newsletter or other regular safety communication

NOTES:


SECTION 2: ACCIDENT PREVENTION PLAN & PROCEDURESMark the appropriate box next to each item. Check one column for each row. If an element does not apply, mark “N/A”.

Yes No N/A Provide safety and health rules that are equal to OSHA standardsProvide safety and health rules that exceed OSHA standardsRequired Job Hazard Analysis (JHA) Job-specific tasksCompany-wide Hazard Communication coordinatorA Job-specific Hazard Communication coordinatorStandard procedure to inform and receive information from other contractors on the same jobsite

New-Hire OrientationHow to report injuries and unsafe conditions and work practicesAn overview of the company’s safety and health requirementsLocation of first-aid kits/facilitiesUse and care of Personal Protective Equipment (PPE)Actions to take in the event of emergenciesOverviews of the company’s discipline procedures and enforcement policyCompany’s roles and responsibilities in the safety program

Employee Training and Documentation that includes:Have personnel on each job trained in first-aid CPRSupervisors with OSHA extensive (i.e. 10/30-hr) hazard recognition/competent person training certificationFall Protection SystemsForklift operator training certification and evaluationCompetent person safety training applicable for your business (i.e., Scaffolds, trenching and excavations, etc.)Fire Prevention Hazard CommunicationDefensive DrivingUse of Personal Protective Equipment (PPE) and RespiratorsConfined Space HazardsAsbestos Hazard AwarenessLead Hazard AwarenessSilica Dust Hazard AwarenessManual Lifting Hazard Awareness

SECTION 2: ACCIDENT PREVENTION PLAN & PROCEDURES (CONTINUED)


Mark the appropriate box next to each item. Check one column for each row. If an element does not apply, mark “N/A”.

Yes No N/A Electrical Hazards, including Lockout/Tagout proceduresSite-specific risks and hazard awarenessTraffic Zone Hazard Awareness and FlaggingPermit Procedures and TrackingProvide Safety Training in a language other than EnglishProvide written material and signs in language other than English

A Written Policy or Procedure that includes: Fall Protection PlanBlood borne Pathogens Exposure Control PlanHeat Illness Prevention ProgramFire Prevention and Emergency Action PlanAsbestos and Lead ProceduresTrenching and Excavation ProceduresTraffic Control PlanVehicle Driver Selection and Fleet Safety PolicyAssured Equipment Grounding or GFCI ProgramDisciplinary Procedures and Enforcement of Subcontractor Safety Workplace Violence and Harassment policyExplosives and Detonation Safety PlanPre-lift cranes or hoisting equipment planBehavior-based observations and reportingLockout/Tagout of hazardous energy sourcesQuality Assurance/Quality Control Plan Demolition PlanMuscle Strain Prevention ProgramRoot Cause Analysis on All IncidentsPermit-Required Confined Space Entry ProceduresHazardous Communication ProgramWritten Cell Phone PolicyCode of Safe PracticesSafety Performance Recognition Program


NOTES:


SECTION 3: DESIGNATED SAFETY COORDINATOR/MANAGER/COMMITTEEMark the appropriate box next to each item. Check one column for each row. If an element does not apply, mark “N/A”.

Yes No N/A Safety responsibilities clearly defined in writingReports to executive management or executive committeeAttends management and project safety meetingsSafety Professional is member of AGC of California Safety & Health CouncilSafety Professional is member of American Society of Safety Engineers or other professional safety organizationsHas degree or professional certificates in safety and healthConducts and records safety inspectionsConducts and records accident investigationsCrisis Management TrainingDiversity TrainingLeadership TrainingMakes decisions on Safety Procedures and Policies

NOTES:


SECTION 4: EMERGENCY PROCEDURES AND FIRST AID/CPRMark the appropriate box next to each item. Check one column for each row. If an element does not apply, mark “N/A”.

Yes No N/A First aid and CPR Certifications (Current and Up-to-Date)Written emergency procedure plan for evacuationCrisis Management PlanHave the appropriate/adequate first-aid supplies and equipment on a jobsiteHave an emergency rescue plan in place for a fall and caught-in-between victim (i.e. falls, excavations, confined space, etc)

SECTION 5: INSPECTIONS, ACCIDENT INVESTIGATIONS, AND REPORTS

Yes No N/A Maintain safety and health recordkeeping requirementsProvide safety inspection and accident investigation proceduresInjury accidents are investigated promptly after an occurrence and a report is presentedAccident reports are reviewed regularly to determine correctionsRequire safety and health inspections of each jobsite at least weekly by the supervisorSafety and health issues are discussed and addressed at each job progress meeting with the other contractorsRequire safety and health inspections of each jobsite by the company safety director or project manager at least monthlyAn investigation procedure in place for near missesDaily site inspections conducted by competent personSite inspections documented

NOTES:


SECTION 6: CONSISTENT USE OF SAFETY POSTERS AND POSTED INFORMATIONMark the appropriate box next to each item. Check one column for each row. If an element does not apply, mark “N/A”.

Yes No N/A All required Federal and State forms and notices posted at jobsite Post Injury and Illness records such as 300A form Communicate all environmental monitoring and test data with employees (i.e. post

the results of air tests) Use warning signs on jobsites to alert workers to hazards Safe Practices and rules posted

Crane or material handling hand signals posted

SECTION 7: SUBSTANCE ABUSE POLICY PROCEDURES

Yes No N/A Written Drug and Alcohol Prohibition policyDrug Testing ProtocolAlcohol Testing ProtocolEmployee Assistance Program or Counseling Referral ProgramInclusion of Subcontractors in testing policy

NOTES:

SECTION 8: SITE-SPECIFIC SAFETY PLANSAGC of California Construction Safety Excellence Awards Application


Yes No N/A Documented Pre-planning process/listsWeekly Safety Meetings (Tool Box Safety Discussions)Jobsites, offices, shops, and yards are inspected at least weekly by supervisors Daily Weekly Other Documented (check all that apply)Written site-specific plans (fall protection, confined space, etc.)

SECTION 9: PARTICIPATION IN AT LEAST ONE CONSTRUCTION SAFETY ACTIVITY BY ONE OR MORE EMPLOYEES

This section would include all safety and occupational health related seminars, workshops and conferences.

Yes No N/A Participate in Cal/OSHA, Cal/SHARP Program or VPPCConstruction related association training classActive participation in a construction related association Safety Committee (specify organization in NOTES section below)Academia sponsored safety seminar/conference (i.e. college, university, or junior college)Local or regional safety seminars

NOTES:


SECTION 10: RETURN-TO-WORK PROGRAM AND MEDICAL MANAGEMENTMark the appropriate box next to each item. Check one column for each row. If an element does not apply, mark “N/A”.

Yes No N/A Written Return-to-Work (RTW) programWritten Modified Duty tasks or descriptionsCoordination with physicians/modified duty descriptionsDocumentation of supervisory training in RTW criteriaWritten claims management policy and procedure

SECTION 11: SUBCONTRACTOR MANAGEMENT

Yes No N/A Subcontractor/Contractor Liaison policyEvery worker, including subcontractor employees, completes safety orientation for each projectAt least monthly manager/supervisor/project management safety meetingsSubcontractors submit site-safety plansSanctions applied for subcontractor non-compliance with safety standardsSafety and health policy requirements written into contracts to compel subcontractors to meet your safety requirementsPre-qualification of subcontractors includes safetyPreconstruction safety meetings conducted with subcontractors

NOTES:

SECTION 12: GENERAL CONTRACTORS/CONTRACT MANAGERSAGC of California Construction Safety Excellence Awards Application


Yes No N/A Provide OSHA 10 hour training to field employeesProvide 30 hour OSHA training to field management staffTrack subcontractor work hours by site or projectTrack subcontractor related injuries by site or projectHave a mandatory 100% -6 foot fall protection requirement for all trades OR adhere to the Cal/OSHA ran programDoes your company participate in any OSHA partnerships or alliancesDo you offer your subcontractors free OSHA 10 or 30 hour trainingDo you utilize Cal/OSHA Consultation servicesRequire JSA (Job Safety Analysis) use by subcontractors for daily operationsRequire daily written crane inspectionsRequire crane pre-task planning for all picksRequire 3rd party crane inspections prior to crane operational start upDo you conduct daily pre-task meetings with involved trades covering high hazard workDo you conduct a project-wide muscle strain prevention program

NOTES:


PART III:

SECTION 1: DESCRIPTION OF SAFETY PROGRAMProvide no more than two pages (12 font, Times New Roman, with at least 1 inch margins) describing your safety program and your commitment to safety and health with an overview of its implementation, addressing all the criteria that applies. Use this part as a guide to prepare the written description (qualitative description) of your safety program. Please include information about your orientation program, training program, recognition program, innovative practices and those elements described in the following table. Participant Involvement:Consider how the individuals closest to the daily work make decisions that improve safety. Please write about how your project managers/superintendents ensure that everyone is able to participate in the decision making process when it comes to safety. Open discussion:Consider how your project managers/superintendents ensure that there are open discussions about safety – how they communicate their expectations. Please write about a time when your project managers/superintendents made safety a priority in order to push a key project forward. Visible Management Commitment:Consider how your project managers/superintendents perform their daily site activities. Please write about a time when you had to communicate safety expectations to your customer while handling a number of competing priorities like schedule and quality.


SECTION 2: WHY YOU DESERVE TO WIN

Provide no more than two pages (12 font, Times New Roman, with at least 1 inch margins) describing your safety program and your commitment to safety and health with an overview of its implementation,


addressing all the criteria that applies.

Be creative. This is your opportunity to demonstrate that “special something” that sets you apart from the others – your core competency in safety. Explain the things that you feel you do better than everyone else. Judges will be evaluating the following:

Overview of company safety program High level of employee involvement in safety New programs, procedures or resources used by company to promote safety Management’s involvement/commitment to safety Unique program elements used by company to promote and heighten safety awareness.


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