ARPM Safety Award Application

The Association for Rubber Products Manufacturers (ARPM) invites you to participate in the 2019 Safety Awards Program. The Safety Awards Program is a way to recognize safety in the industry and facilities that have achieved a level of safety performance above the industry average. Awards are based on data reported on a company's annual OSHA 300 Log of Work-Related Injuries and Illnesses. What's required to submit: Completed submission form Copy of the facility’s OSHA 300 and 300A forms

Company Name

Company Location

Average Number of Employees in 2017

Average Number of Employees in 2018

Total Hours Worked in 2017

Total Hours Worked in 2018

Total Deaths in 2017

Total Deaths in 2018

Job Transfer/Restriction (remained at work) 2017

Job Transfer/Restriction (remained at work) 2018

Other Recordable Cases in 2017

Other Recordable Cases in 2018

# of Days Injured worker was Away from Work 2017

# of Days Injured worker was Away from Work 2018

Job Transfer/Restriction (away from work) 2017

Job Transfer/Restriction (away from work) 2018

Injury in 2017

Injury in 2018

Skin Disorder in 2017

Skin Disorder in 2018

Respiratory Condition in 2017

Respiratory Condition in 2018

Poisoning in 2017

Poisoning in 2018

Hearing Loss in 2017

Hearing Loss in 2018

All Other Illnesses in 2017

All Other Illnesses in 2018

How many of the injuries were Amputations in 2017

How many of the injuries were Amputations in 2018

Reported By: (NAME)

Email:

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