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2021 Construction Safety Week - Certificate of Participation
To receive a certificate of participation, please complete the entire form. If you have any questions, please contact Nazia Shah at nazia.shah@agc.org or (703) 837-5409.
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1.
Company Information
(Required.)
Name
Address
# Employees
*
2.
Which AGC chapter(s) do you belong to?
(Required.)
*
3.
Contact Information (person completing form)
(Required.)
Name
Job Title
Email
Phone
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4.
How many years have you participated in Construction Safety Week?
(Required.)
1 - This is our first year!
2
3
4
5
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5.
When and where (city, state) did your event take place? You can input multiple dates and locations.
(Required.)
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6.
Explain the details of your event below, including the topic/focus of the event. If you had different events at different locations, list the location and then describe the event.
(Required.)
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7.
How many of your employees participated in construction safety week, across your company and jobsites?
(Required.)
*
8.
Information for certificate
(Required.)
Company Name (as it should appear on the certificate)
Email Address (where certificate should be sent to)
*
9.
Do you have photos form your event that you would be willing to share with us?
(Required.)
Yes - I'll email them to safety@agc.org
No
10.
Is there any additional information you would like to provide?
