As with 2017, Supervisor and Onsite Worker surveys will be completed anonymously through links to Survey Monkey. Once ICI has received your completed application and accompanying documentation, we will send the Survey Monkey links to the person who completed the form. Contractors should distribute the supervisor links to your supervisors and the onsite worker survey link to your onsite workers via text or email, and ask them to take the anonymous surveys as soon as possible. Employees can take the surveys using phones, laptops, tablets or jobsite computers. Contractors without the capabilities of doing the surveys electronically should call the ICI office at (317) 634-7547 for paper surveys and instructions.

ICI is requiring a minimum number of completed surveys based on the number of onsite hours worked. However, this year there is no limit to the number of individual supervisors and onsite workers you can ask to participate. We believe the more of your people you can get to fill out these surveys the better the feedback on your safety program.

  • COMPANY INFORMATION

  • Prepared by
  • Company Name
  • Job Title
  • Application Date -- All applications and surveys must be completed by Friday, June 29, 2018 for consideration this year.
  • Email Address
  • Business Phone
  • Please provide your company's address.
  • Total Onsite Hours Worked (NOTE: ICI may adjust your man hours category to balance the number of applications in each category.)
  • Indiana EMR
  • 2017 IN TCIR
  • Please upload a PDF of your company's 2017 OSHA 300 logs (Required).
    Accepted file types: pdf.
  • 2016 IN TCIR
  • Please upload a PDF of your company's 2016 OSHA 300 logs (Required).
    Accepted file types: pdf.
  • 2015 IN TCIR
  • Please upload a PDF of your company's 2015 OSHA 300 logs (Required).
    Accepted file types: pdf.
  • COMPANY SAFETY PROGRAM

  • Does your company have company-wide safety goals? If yes, please list three (3) examples below.
  • Does your company require jobsite supervisors to prepare and/or participate in creating a jobsite safety plan, hazard analysis and preventative action?
  • Please upload a PDF of a sample jobsite safety plan, hazard analysis and preventative action (if available).
    Accepted file types: pdf.
  • Does your company have a written plan to provide task-specific, hands-on training to new hires and employees who transfer to a new task? If yes, please attach a sample pdf or explain below.
  • Please upload a PDF of a sample hands-on training document (if available).
    Accepted file types: pdf.
  • SAFETY PROGRAM COMPONENTS

  • Please upload a PDF of your company's safety program manual table of contents (if available).
    Accepted file types: pdf.
  • TARGETED QUESTIONS - SHORT ANSWER

  • In what activities does your middle/upper management participate to demonstrate their engagement in the company safety program?
  • In what ways does your company encourage a safe work culture?
  • This field is for validation purposes and should be left unchanged.