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Home My WebLink AboutMMIA-Governor's Safety AwardsMMIA Montana Municipal Insurance Authority PO Box 6669 Helena, MT 59604-6669 Please distribute to all appropriate personnel and post in a conspicuous place. DATE: TO: FROM: RE: April 3, 2003 MMIA Program Participants Alan W. Hulse, Risk Manager Montana Municipal Insurance Authority Annual GovernoYs Safety Awards R.M. Bulletin 5-03 It's time again to start thinking about the Annual Governor's Safety Awards, which are presented each year at the GovernoYs Conference on Workers' Compensation and Safety. Each year, employers who have made outstanding achievements in safety and for their personal contribution to the improvement of safety and health in Mon~tana workplaces are recognized. If your organization demonstrates a personal Commitment to safety and has established initiatives in updating the quality of safety programs, then you should consider nominating your municipality for these awards. The MMIA will provide any assistance possible to this nomination, especially in the form of loss reports, trends, or letters of recommendation. The awards are given in four different categories: Large Public Employer (100+ employees) Large Private Employer (100+ employees) Small Public Employer (less than 100) Small Private Employer (lessthan 100) I have enclosed the nomination forms for your convenience. The nominations are due in the Safety Bureau Office by August 1,2003 (postmarked). The awards will be presented at the Governor's Conference on Workers' Compensation and Safety October 1-3, 2003 in West Yellowstone. If you have any questions or need assistance please give me a call at 1-800-635-3089. This newsletter is published as a service to our members. documents. All coverage determinations are made on a case-by-case basis, and can only be viewed on the unique facts of the claim presented. GOVERNOR'S AWARDS PROGRAM FOR SAFETY AND HEALTH 2O03 FEB 2 6 ZO0~ PURPOSE The Governor of Montana and the Montana Department of Labor and industry annually recognizes private and public employers that have made outstanding achievements in Workplace Safety and Health. The Governor's Awards for Safety and Health are the highest honor given by the State of Montana for recognition of an employer's commitment to excellence in Workplace Safety and Health. It is the intent of the Governor and the Commissioner of Labor, through this recognition, to promote a greater awareness of Workplace Safety and Health throughout the State of Montana. A WARDS Each award recipient will receive a plaque that will be appropriately inscribed. Awards are to be presented by Governor Martz. The Governor's Conference on Workers' Compensation and Occupational Safety and Health will be held at the Holiday Inn Sunspree Resort in West Yellowstone, October 1-3, 2003. AWARD CATEGORIES · Large Private Employer of the Year (100+ employees) · Large Public Employer of the Year (100+ employees) · Small Private Employer of the Year (Less than 100 employees) · Small Public Employer of the Year (Less than 100 employees) · Mines and Sand & Gravel operations (All) Please direct any question you have about determining your organization's size to the Montana Occupational Safety and Health Bureau. -I- NOMINATION PROCEDURES Interested individuals (employer, employee or other associated personnel) may submit a nomination for a business, agency or organization. Self-nominations are welcome and encouraqed. P/ease note that the Department of Labor and Industry, Occupational Safety and Health Bureau cannot and will not nominate employers for these awards. GENERAL INFORMATION 7.. Hard copies of the application packet may be faxed or delivered through regular mail to the Occupational Safety and Health Bureau. 2. Applications are also available in electronic format and can be submitted via e-mail. Obtain applications electronically at the Montana Occupational Safety and Health Bureau web page: www. montanasafety.com. 3. All applications must be post marked, or received via regular or electronic mail by August 1, 2003. 4. Please submit your applications to: John Maloney, Bureau Chief Montana Occupational Safety and Health Bureau Montana Department of Labor and Industry P,O. Box 1728 Helena, MT 59620 jmaloney@state.mt.us FAX:(406)-444-9396 5. Applications must be typed or printed legibly and should follow the outlined format. Information submitted in an improper format or in excess of that detailed in this application, might not be reviewed or considered. Only one nomination is allowed per application. 7. A committee appointed by the Commissioner of Labor will evaluate applications. Their decisions will be final. -2- APPLICATION INSTRUCTIONS As you develop your application please keep in mind that the awards are presented to employers who, with their employees, have demonstrated personal commitment to workplace safety and health by establishing programs, plans, procedures, and initiatives that help ensure the safety and health of workers in the workplace. Evaluation criteria is based on accepted and published safety and health principles as set forth by the state of Montana through the Montana Safety Culture Act and OSHA through its published Elements of an Effective Safety and Health Management System. Please provide the following information in your application: t. Cover Sheet: Fill out, print, and attach the cover sheet on page 5. 2. Significant Details of Employer's Safety and Health Program: Describe how you have incorporated the 5 elements (listed below) of an effective safety and health management system into your program. Explain how your program is set up and tell about its attributes. Relate success stodes and give examples of program effectiveness. (3-page limit) A. Management Leadership and Employee Involvement B. Worksite Analysis C. Hazard Prevention D. Hazard Control E. Safety and Health Training 3. Supplemental Information: Include significant milestones, achievements, awards, and other pertinent information. Please focus on events after 1998. (1- page limit) Please note that details about an employer's Safety and Health Program and Supplemental Information pdor to 1998 may not carry the same weight as more recent developments. -3- APPLICATION INSTRUCTIONS 4. Occupational Injury and Illness Data: Please include Occupational Injury :and Illness data from the last three (3) years, 2000, 2001 and 2002, in your application. Employers may elect to send copies of OSHA 200/300 or Montana 200 forms or submit data using the attached form on page 6. Be sure to include the number of employees for each year with your injury illness data. Mining and Sand & Gravel Companies must attach MSHA 7000-1 Forms for years 2000, 2001 and 2002. IPlease note that submittal of Occupational Injury and Illness data is required. Lack of data is grounds for disqualification. 5. Endorsements: The limit is two (2) endorsements, with a maximum of one (1) page for each. (Someoneoutside of your company that has a good working knowledge of your safety and health program should make endorsements, for example; safety professionals, industrial hygienists, representative from your workers' compensation insurer, representative from a union, etc.) Please note that members of Montana's Occupational safety and Health Bureau staff may encourage organizations to submit nominations, but they ara not able to and will not endorse nominations. · 6. Applicant's Statement: Print, sign, and attach the applicant's statement on page 6. COVER SHEET Nominated Employers Name: Address: Phone Number: Type of Business: Category: (Select one) Large Private Employer (100+ employees) ~ Private [~ Public Small Employer (Less than 100 employees) ~ Private [~ Public [~ Mines and Sand & Gravel Operations (All) Average Annual Number Employees: (Fill out if different from information entered above.) Nomination submitted by: Affiliation to Nominee: Address: -5- I 2000 t 2004 I 2002 Fatalities: (Sum of blocks 1 & 8 on OSHA/MT 200) Block G on OSHA 300) Days away from work or restricted work activity or both: (Sum 0f blocks 2 & 9 on OSHA/MT 200) Days away from work: (Block H on OSHA 300) Job transfer or restriction: (Block I on OSHA 300) Other recordable cases: (Sum of blocks 6 & 13 on OSHA/MT 200) Block J on OSHA 300) Avg # Full Time Employees: Private employers please provide your SiC if it is known (Employer will not be penalized for not knowing SIC.) · Mining and Sand & Gravel Companies attach MSHA 7000-i Forms for years 2000, 2001 and 2002. Signature Date Please be advised that any falsification of information or details is grounds for disqualification. -6- APPLICATION CHECKLIST (Do not include with application) 1. Is the cover sheet complete and included with the application? 2. Are significant details of your Safety and Health Program limited to three (3) pages total? 3. Did you include a supplemental information sheet limited to one (1) page total? 4. Did you include your Occupational injury and illness data and the number of employees for each of the last three (3) years? 5. Are endorsements attached and limited to, two (2) endorsements, maximum of one (1) page for each? 6. Is the Applicant's statement signed and attached? Thank you for taking time to fill out this appfication! Question may be directed to the Montana Occupational Safety and Health Bureau at (406)-444- 6401. -7-