RMCMI Contractor Safety Award Application

If you would like to recommend an outstanding contractor for their safety performance during calendar year 2010, please fill out the form below and submit to mail@rmcmi.org All applications will be reviewed and judged by the awards committee with the winning recipients being recognized at the RMCMI Convention and Annual Meeting. This form can be submitted by either a contractor or mine operator. A contractor is not eligible if they experienced a fatal or life-threatening event during the year. 1. Contractor (company name) to be recognized:_______________________________________________ 2. Contractor contact: Name:_______________________________ Phone:_________________________ 3. Indicate which category best describes the Contractor’s work: ______Operational Support Services (development, mining, maintenance, reclamation etc) or ______Non Operational Support (Engineering, cleaning services, security, consulting etc) 4. Individual and company making recommendation: __________________________________________ 5. Mine operator contact where contractor has worked: Name:_____________________ Phone:_________ Please fill out the information below to the best of your knowledge Category Number of contractor hours during the year Average number of employees contractor has on site Number of MSHA reportable injuries Number of Lost-time injuries Total lost work days Does the contractor have a formal safety program in place Is the contractor a current member of RMCMI (At the time of nomination, the contractor does not have to be a member; however, have a discussion about being a RMCMI member with them. Final award recipients must be members when the award is presented) Calendar year 2010

Please include a discussion as to why this contractor should be recognized for their safety achievements. This area is critical as it will be weighted very heavy in the selection process. Include items like innovative practices, comprehensive training program, frequency of safety meetings, use of safety tools (stop work cards, life saving rules etc.) (Attach additional sheets if necessary): __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________
The Rocky Mountain Coal Mining Institute 3500 S. Wadsworth Blvd, Suite 211 Lakewood, CO 80235 Phone: 303/948-3300 │ Fax: 303/954-9004 www.rmcmi.org │ mail@rmcmi.org

A 501(c)(3) Nonprofit Educational Association founded November 11, 1912 for members representing the coal industry

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