28th Annual National AGC Safety Awards
SUBMIT BY FEBRUARY 12th at Noon to Qualify

Complete your OSHA form 300A “Summary of Work-Related Injuries and Illnesses” for 2017.
Review your OSHA form 300A and note:
Section (G) “Fatality Information”;
Section (H) “Cases with Days Away from Work”;
Section (I) “Cases with Job Transfer or Restriction”;
Section (J) “Other Recordable Cases”; and
Employment Information Section for your company work hours.


Report your company’s numbers from the OSHA form 300A section (G), section (H), section (I), section (J) and work hours to your AGC Chapter contact person, via e-mail, telephone, fax, or mail.

Company Name (as it should appear on the award):
Your answer
Contact Person (Name and Phone Number):
Your answer
AGC Division/Construction Type ( Select the AGC division/construction type that accounts for the majority of company work hours.):
Section (G) “Fatality Information”. Number of Fatalities:
Your answer
Section (H) “Cases with Days Away from Work”. Number of Cases:
Your answer
Section (I) “Cases with Job Transfer or Restriction”. Number of Cases:
Your answer
Section (J) “Other Recordable Cases”. Number of Cases:
Your answer
Employment Information. Total Hours Worked (for selected Construction Type):
Your answer
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