The Inaugural Indiana PHCC Safety Awards Program is developed to recognize all members outstanding efforts in safety. Further, the aim of this new initiative is to help all Indiana PHCC contractor members create a vision of safety by identifying areas internally which can be improved for overall safety protocol.


The process is simple. Fill out the online survey. All submissions are then reviewed by the Indiana PHCC Safety Awards Program Committee, comprised of a select group of safety experts. Feedback will given and recognition provided to PHCC members who meet or exceed the requirements set forth.

All PHCC Members Please Complete the first 18 questions. If you are a company of 2-9 employees, then you must complete questions 1-36. Companies with 10 or more employees must complete the whole survey.


You may begin.

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1. Company Name

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2. Address of Company

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3. Person Filling Out Survey

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4. Email of Person Filling Out Survey

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5. Phone Number of Person Filling Out Survey

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6. Best way to contact you

Let's Get Started with the Survey Questions!

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7. Do you inspect your tools and equipment on a regular and frequent basis?

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8. Are these inspections documented?

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9. Do you inspect your Personal Protective Equipment (PPE) on a regular and frequent basis?

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10. Are these inspections documented?

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11. Do you maintain Safety Data Sheets (SDS) on materials you use?

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12. Do you update these SDSs to remain current?

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13. Have you received Safety training in the last 12 months? (examples - Fall Protection, Confined Space, Excavation, Ladders, Scaffolding etc.)

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14. Please list the safety training topics covered over the last six months.

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15. Total Number of Employees (for Committee purposes)

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16. Total Number of Licensed Plumbers

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17. Total Number of Licensed HVAC Technicians

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18. Total Number of Other Licensed Technicians/Trades People

Stop here if you are Sole Proprietor (no employees). All others, please continue

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19. Do you have all required and updated OSHA posters in place?

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20. Do you have a Safety Program / Manual?

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21. Is the Safety Training Manual updated annually?

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22. Do you have a formal Drug Free Workplace Policy?

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23. Do you have a Fleet, Driving Program, which includes inspection check list?

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24. How often do you inspect vehicles and trailers (with documentation)?

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25. Do you have a Distracted Driving Policy and driver training?

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26. Is the Distracted Driving training documented?

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27. Do you have regular Safety Meetings / Tool Box Talks?

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28. Are the Safety Meetings documented with attendees?

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29. What is the frequency of the Safety Meetings?

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30. Do you provide Safety Training for your employees? (examples - Fall Protection, Confined Space, Excavation, Ladders, Scaffolding etc.)

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31. Do you maintain records of the Safety training?

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32. Do you have a current trained 1st Aid / CPR Trained employee? (with a recertification program) Certified by the American Red Cross or similar?

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33. Do you have a New Hire Safety Orientation?

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34. Do you have OSHA 10 Hour trained employees? (Construction / General Industry)

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35. What percentage of your workforce has received OSHA 10 training?

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36. Are accidents investigated to determine the Root Cause, to improve Safety Program?

Stop here if you have fewer than 10 employees. If you have 10 employees or more, please continue with survey

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37. Do you have an OHSA 30 Hour trained employees? ( Construction / General Industry)

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38. What percentage of your workforce has received OSHA 30 training?

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39. Do you have an OHSA #510 Trained employee?

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40. Do you have an OHSA #511 Trained employee?

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41. Do you have an active Safety Committee, or Safety Technician?

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42. Do you have and use Job Hazard Analysis (JHA)?

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43. Do you track and use Near-Miss /Near-Hit reports to improve Safety Program?

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44. Do you maintain an OSHA 300 log and 300A summary? (Applies to a company that employed more than 10 employees during any point during a 12
months period)

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45. What is your company's Experience Modification Rate (EMR)? (Information from your insurance company)

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46. What is your company's Dart Rate? (Dart Rate Calculator can be found at www.creativesafetysupply.com). The calculated DART Rate represents the number of cases resulting in days away, restricted work, or job transfers per 100 full-time equivalent employees.

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47. What is your company's Total Recordable Incident Rate? (Total Recordable Incident Rate calculator can be found at www.safetymanualtoday.com)

Thank you for taking the time to complete the Recognizing Outstanding Proactive Efforts in Safety survey.
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