Heavy Construction Contractors Association

2015 Safety Award Nomination Form

(For Calendar Year 2015)

Note: This nomination form can be completed online, but is not for electronic submission. It is recommended that you fill in the form, save it locally. DO NOT e-mail this form as it must be accompanied by various printed attachments. Send via regular mail to:

Safety Committee
Heavy Construction Contractors Association

8424 Quarry Road Suite 201

Manassas, VA 20110

Business Category

Describe your firm’s primary function in ten words or less:

Your firm’s primary business is in the category(Select from list below):

Review the categories listed below, then select the one in which your firm performs the MAJORITY of its annual volume, and enter that letter in the box above. You may choose to participate in Category F in addition to the category in which your firm performs the MAJORITY of its work.

Category A / Category B / Category C
Structural Concrete
Steel/Structural
Highway Construction / Excavation
Utility Pipe Work
Clearing/Grading / Paving
Road/Street Concrete
Sidewalk/Curb Concrete
Category D / Category E / Category F
Blasting
Tunneling
Pile Driving / General Contractor
Engineer/Surveyor
Plant Operations / Trucking Operations
Fleet Delivery

Eligibility: To be eligible for an award, an applicant MUST:

  1. Be a member in good standing with the HCCA.
  2. Have been in business for at least one full year (2013)
  3. Complete the application fully.
  4. Submit the completed application for receipt at the HCCA office on or before Wednesday – February 24, 2016.

Judging Criteria - The panel of Judges will consider:

  1. The applicant’s written safety policy and philosophies.
  2. Work safety records (OSHA 300 Log).
  3. Safety education and training program(s), including manuals, special programs, in-house awards, and communications (newsletters, posters, brochures, etc.). You may include a copy of the table of contents from your manual(s) as proof of programs.

Award Presentation: The HCCA Safety Awards are presented at the April 2016 HCCA Dinner Meeting.

To be considered, this application MUST be accompanied by:

  1. A statement of Company Safety Policy, signed by company President.
  2. Documentation of your Safety Training for 2015.
  3. OSHA 300 Log for 2015.

If any of the above criteria is missing, the application will not be considered for the award.

Do you have a written Safety Program? Yes No

HCCA’s Safety Awards Program is conducted annually to recognize member firms demonstrating exemplary safety programs, policies, and work records. This program is open to all member firms regardless of size or revenue.

General Information

Firm Name:

Name of Safety Director:

Submitted by:

Title of Submitter:

Location of Corporate Office:

Mailing Address:

City: State:Zip:

Telephone: Fax:

Email:

Average number of construction employees in 2014 (annual):

Total man-hours worked in calendar year 2015 for Categories A, B and C in accordance with the following criteria:

-Under 100,000 man-hours worked:

-Over 100,000 but under 1,000,000 man-hours worked:

-Over 1,000,000 man-hours worked:

Number of Utility Hits (if applicable):

Trucking Operations (Category F)Open to All Applicants

Awards may be given in each of the following weight categories. Note: Only count your corporate trucks for this award – do not count sub’s trucks.

Under 26,000 GVW:

Total Company Miles Driven (approximately):

Total Number of Vehicles:

Number of accidents over $500 (regardless of location or fault):

Over 26,000 GVW:

Total Company Miles Driven (approximately):

Total Number of Vehicles:

Number of accidents over $500 (regardless of location or fault):

Program Evaluation Qualifiers (OSHA 300 Log)

  1. Total Number of Fatalities in 2015:
  2. Total Number of DART Lost-Time Cases in 2015:
  3. Total Number of Work Days Lost Due to Accidents in 2015:

--- For Judge Use Only – DO NOT WRITE IN THIS SPACE –

Frequency rate in 2015 (Use formula):

= 200,000hours x # of Accidents/man hours

DART Rate in 2015 (Use Formula):

= # cases from logXtotal man hours/200,000 hours

Questions about the 2016 HCCA Safety Awards may be addressed to any Member of the Safety Committee as listed below:

Robby Oliff, Co-Chair The Lane Construction Corporation(703) 929-1660

Todd Atkins, Co-ChairSuperior Paving Corporation(703) 631-0004

Glenn Kauffman, Co-ChairThe Kauffman Group(703) 737-7371

Luis AlemanThe Anderson Company(703) 393-4000

Patrick Doering The Anderson Company(703) 393-4000

Patrick HewittNational Trench Safety(703) 330-5104

Joe KuceraTotal Development Solutions(703) 318-9887

Jay GoffWilliam A. Hazel, Inc.(703) 378-8300

Stacy TanksK.D. Jones and Sons Trucking (703) 898-0313

Jonathan WomackInsight(540) 968-6612

Justin LillyInsight

Fred MorganLuck Stone

Rachael MurphyBranscome Paving(703) 434-1630

Jarod StevulakAtlantic Contracting and Materials(703) 572-7847

Kenny Jenkins Luck Stone(202) 591-6908

Ken GarrisonHCCA(703) 392-7410

Robbyn SmithHCCA(703)-392-7410

All information and attachments provided herein are considered CONFIDENTIAL.

Information is not for dissemination for any purpose other than for review

by the HCCA Safety Committee Members for the determination of HCCA Safety Awards.