REQUIRED COMPANY INFO

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* Prepared by:

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* Application Date -- All applications must be completed by Friday, Aug. 13, 2021

Date

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* Total On-site Hours Worked in 2020 (NOTE: ICI may adjust your worker hours category to balance the number of applications in each category.)

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* 2018 Indiana EMR

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* 2018 OSHA 300 Logs

PDF file types only.
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* 2019 Indiana EMR

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* 2019 OSHA 300 Logs

PDF file types only.
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* 2020 Indiana EMR

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* 2020 OSHA 300 Logs

PDF file types only.
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* Please upload a PDF of your company safety program here.

PDF file types only.
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