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TOPS Award Application
Part 1: Company Demographics and Statistics
Company Name
(Required)
Company Physical Address
(Required)
Street Address
Address Line 2
City
State
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
ZIP Code
Type Application Submitted
(Required)
Project
Program
Submitted Project Name and Location
Project/Program Name
(Required)
Project/Program Location
(Required)
Provide a brief description of the submitted project/program (approximately 25 words) in the box below, which can be used at the awards ceremony to introduce your company as the award is presented. Upload a separate page if needed.
(Required)
Upload an additional page if needed.
Max. file size: 64 MB.
Submitted Project Category: Work hours inclusive of all trade contractors (Select only one category per application)
(Required)
Select One
Category 1 (<60k work hours)
Category 2 (>60k - <250k work hours)
Category 3 (>250k - <750k work hours)
Category 4 (>750k work hours)
Provide the following statistics for the overall company/organization: Data to be taken from OSHA 300/300A (submit copies of OSHA 300/300A Data)
OSHA 300/300A
(Required)
Upload copies of OSHA 300/300A below:
Drop files here or
Select files
Max. file size: 64 MB, Max. files: 3.
Note: Statistical Data Weighting Factor 20%
A. Total Hours Worked
(Required)
2023
2022
2021
B. # Fatalities **
(Required)
2023
2022
2021
C. # Lost Workday Cases
(Required)
2023
2022
2021
D. # Restricted Day Cases
(Required)
2023
2022
2021
E. # Other Recordable Cases
(Required)
2023
2022
2021
F. # Total Recordable Cases (sum of C thru E)
(Required)
2023
2022
2021
Experience Modification Ratio (EMR)
(Required)
2023
2022
2021
Recordable Incident Rate (TRIR) (F x 200,000/A)
(Required)
2023
2022
2021
Lost Workday Case Rate (LWCR) (C x 200,000/A)
(Required)
2023
2022
2021
Days Away/Restricted or Transfer Rate (DART) ([C + D] x 200,000/A)
(Required)
2023
2022
2021
North American Standard Industry Classification (NASIC)
(Required)
**Corporate fatalities considered in score weighting but do not result in disqualification unless experienced within the TOPS submission year.
Part 2: Project/Program Statistics
Provide the following statistics for the submitted project/program (most recent three years). Provide work hours and statistical data for all personnel managed by the applicant company inclusive of subcontractors for the applicable years.
NOTE: Statistical Data Weighting Factor 80%
Submitted Project Start Date
(Required)
Month
Day
Year
Submitted Project Completion Date
(Required)
Month
Day
Year
Total Hours Managed (Inclusive of subcontractors)
(Required)
2023
2022
2021
# Fatalities (Inclusive of subcontractors) **Immediate disqualification
(Required)
2023
2022
2021
# Recordable Cases (Inclusive of subcontractors)
(Required)
2023
2022
2021
Recordable Incident Rate (TRIR) (Inclusive of subcontractors)
(Required)
2023
2022
2021
# OSHA/MSHA Citations*** (Inclusive of subcontractors)
(Required)
2023
2022
2021
Upload necessary files
*** Upload a separate file providing details of each OSHA/MSHA citation. Emphasis on why the citation event occurred, contributing factors, and actions taken to reduce the potential for future occurrence. (NOTE: MSHA citations will be weighted differently from OSHA citations.)
Max. file size: 64 MB.
Part 3: Project/Program Questionnaire
Safety Leadership / Responsibilities
1. Describe corporate commitment to safety on the submitted project/program. Provide examples of corporate/upper management involvement. (150 words maximum. Bulletize responses where possible.)
(Required)
2. Did the project/program utilize a full-time safety professional?*
(Required)
Yes
No
a. If yes, list qualifications of the individual:
(Required)
b. If no, identify who was assigned Safety-related duties:
(Required)
3. Was the client an active partner in the safety of the submitted project/program? *
(Required)
Yes
No
Provide a brief description of client involvement and partnership in the project/program. (Bulletize responses where possible.)
Safe Execution of the Work
1. Identify the project/program preplanning activities used:
Pre-Project Risk Assessment/Mitigation Plan
Your Personnel Only
Inclusive of all Sub-trades
Daily JSA/Task Planning
Your Personnel Only
Inclusive of all Sub-trades
High Hazard Activity Pre-construction Conferences
Your Personnel Only
Inclusive of all Sub-trades
Other
Your Personnel Only
Inclusive of all Sub-trades
If Other was selected above, please provide a description.
2. Identify Safety Engagement Activities used:
Daily JSA/Task Planning
Your Personnel Only
Inclusive of all Sub-trades
Project-Wide Safety Meetings
Your Personnel Only
Inclusive of all Sub-trades
Flex & Stretch Program
Your Personnel Only
Inclusive of all Sub-trades
"Good Catch" Program
Your Personnel Only
Inclusive of all Sub-trades
Behavioral-Based Processes (Worker Observation)
Your Personnel Only
Inclusive of all Sub-trades
Project Celebrations/Luncheons
Your Personnel Only
Inclusive of all Sub-trades
Incentive/Reward Program(s)
Your Personnel Only
Inclusive of all Sub-trades
Other
Your Personnel Only
Inclusive of all Sub-trades
If Other was selected above, please provide a description.
Provide brief outline of which were successful and least successful and why. (Bulletize responses where possible)
(Required)
Provide brief description of your incentive/reward program and implementation. (Bulletize responses where possible)
(Required)
3. How often were documented safety inspections required?
(Required)
Daily
Weekly
Monthly
4. Documented safety inspections were required for:
Corporate Management
(Required)
Your Personnel Only
Inclusive of all Sub-trades
Project Management
(Required)
Your Personnel Only
Inclusive of all Sub-trades
Site Supervision
(Required)
Your Personnel Only
Inclusive of all Sub-trades
Crew Foremen
(Required)
Your Personnel Only
Inclusive of all Sub-trades
Designated Safety Representative
(Required)
Your Personnel Only
Inclusive of all Sub-trades
Safety Performance/Communications
1. Did the project track the following incident data?
First Aid Cases
(Required)
Your Personnel Only
Inclusive of all Sub-trades
Property Damage Cases
(Required)
Your Personnel Only
Inclusive of all Sub-trades
Near-miss Incidents
(Required)
Your Personnel Only
Inclusive of all Sub-trades
Vehicle/Mobile Equipment Incidents
(Required)
Your Personnel Only
Inclusive of all Sub-trades
Recordable Cases
(Required)
Your Personnel Only
Inclusive of all Sub-trades
Environmental Incidents
(Required)
Your Personnel Only
Inclusive of all Sub-trades
How were accident/incident cases used/communicated? Frequency?
(Required)
Project/Program Best Practices
1. Identify unique safety challenges on the submitted project/program and how they were addressed.
(Required)
2. Identify three (3) best practices and/or lessons learned for the submitted project/program.
(Required)
Best Practice 2
(Required)
Best Practice 3
(Required)
Vendor/Supplier Recognition
Would you like to nominate your safest project vendor/supplier for recognition?
(Required)
Yes
No
If so, provide an explanation of why you would recognize their safety performance along with a contact name, address, phone number, and website URL for the nominee.
Upload additional files if needed.
Accepted file types: pdf, Max. file size: 64 MB.
Release of Application Information
Checking this box allows the SCOAR Safety Committee to share application information with other SCOAR members.
(Required)
I agree
Checking this box allows SCOAR to feature your company as a TOPS Award Winner in emails to member companies, in press releases, SCOAR's Voice Magazine, and on SCOAR's social media platforms.
(Required)
I agree
Submittal Endorsements
Submittal Prepared by
(Required)
Title
(Required)
Email
(Required)
Phone
(Required)
Signature
(Required)
Date
(Required)
Month
Day
Year
Corporate Officer / Designate Certification I certify that information contained herein has been verified and is accurate.
Signature
(Required)
Date
(Required)
Month
Day
Year
Name
(Required)
Title
(Required)
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