2016MAA Safety Awards Program
Entry Form
The Annual MAA Safety Award Program is a way to recognize members that encourage and promote a safe work environment.
In the spirit of continual improvement, we are pleased to announce that new this year the Annual MAA Safety Awards has changed. This year the safety awards will be presented to those companies that have had “Zero MSHA Recordable Injuries” in 2016.
To be considered for a 2016 MAA Safety Award, please complete the enclosed form and return it to the MAA Office by February 28, 2017.
Award recipients will receive a plaque that can be proudly displayed in the main office as well as a 3 ft by 5 ft banner that can be displayed at the entrance of the award winning facility(s).
All submittals require a $100 application fee which includes one plaque and one banner. If additional banners are requested for multiple locations, please include an additional $50 for each additional banner.
All award recipients will be announced during the April 20, 2017, MAA Awards Banquet that will be held at the Country Club of Lansing.
Help us recognize our industry’s commitment to safety by participating in the MAA’s Safety Award Program.
If you have any questions call the MAA office at (517)381-1732.
Company:
Address:
City:State:Zip:
Phone:Fax:
E-mail:
Please make sure to include the following application fee:
Basic application fee (includes one plaque and one banner) - $100
Additional banners for multiple locations - $50
In the space below, please list all separate plants operational in 2016 including the total number of hours worked for the year (a), the number for recordable injuries for 2016 (b), and how many months/years since that site’s last lost time injury. Please print all information and use a separate sheet if necessary. Even if you had recordable injuries, please fill out this form as the MAA uses this information to compile statewide frequency rates.
Total
PersonnelNumber ofMonths Hours Recordable Since
WorkedInjuries forLast Lost
Plant NameLocationSuperintendentIn2016 (a)2016 (b) Time Injury (c)
(a)Indicate MSHA reportable hours for the following subunit codes (03 for our regular surface quarries, 06 for sand & gravel dredging operations, 30 for production plants (crushing/screening operations), 99 for scale-house operations). Do notinclude such activities as concrete and bituminous plants, block plants, etc.
(b)Recordable injuries as reported on MSHA Form 7000-1 and in accordance with 30 CFR Part 50.
(c)Lost-time accidents and workdays charged are those prescribed by MSHA regulations.
Submitted by:Date:
PLEASE RETURN BEFORE FEBRUARY 28, 2017 TO:
Michigan Aggregates Association
6015 W. St. Joe Hwy, Suite 103, Lansing, MI 48917
Fax: 517.381.1796 – E-mail: