Safety Contest

Safety Contest Report Form

 
2009 APPA Safety Contest Annual Report Form

Deadline for Entry: February 5, 2010

To submit your information for the 2009 APPA safety contest please completely fill out all the questions below and click the 'done' button at the bottom of the page when finished.

To submit this survey to APPA all questions must be answered.

When you are finished, please print a copy for your records.

Please keep in mind that only APPA member electric utilities are eligible to receive an award. Although we encourage joint action agencies and state associations/agencies to provide safety data, they are not eligible to receive an award at this time. Data will be used for consideration of a new awardee group in the future.

If you have any questions or concerns please e-mail or call Alex Hofmann at 202.467.2989 / ahofmann@appanet.org


1. Utility Information:
2. Name on Award Plaque**:

IMPORTANT: This question refers to the name of the receiving utility

**In the event that your utility receives an award, this is the name and city/state that will be printed on your award plaque. The first line of the plaque will display the name of your utility and the second line will display the name of your city and state. Please carefully type in the name of the utility, as the plaque will be printed with this information exactly as it is entered below. You are limited to 100 characters for each field.


3. Organization Type* (Please Mark Only One)

*Please keep in mind that only APPA member electric utilities are eligible to receive an award. Although we encourage joint action agencies and state associations/agencies to provide safety data, they are not eligible to receive an award at this time; data will be used for consideration of a new awardee group in the future.
4. Employment

Important: Please show all requested information applicable to the electric utility.
Summary of Accident Experience for the Period January 1, 2009 through December 31, 2009.

A. Employment Information:
5. Cases
(Work related only)- Only count a case once, e.g., if a “days away from work” case also required “medical treatment,” only note one case in Category 2 or 4 as appropriate. See Safety Contest Brochure (available online) for definitions and explanations.

In question 6, the total number of cases (B.5) and the total worker hours exposure (A.1) are used to determine the incidence rate as calculated.

B. Reportable Injuries and Illness Cases:
6. Days

C. Time Charges: (Calendar Days Only)
7. Attributable Cases

D. Number of Cases Attributed to Generation:

Please allocate the number of cases that you had this year by type in the fields below

Note: Put 'NA' when “Not Applicable” and 'DU' when “Data Unavailable”.
8. Attributable Cases

D. Number of Cases Attributed to Distribution:

Please allocate the number of cases that you had this year by type in the fields below

Note: Put 'NA' when “Not Applicable” and 'DU' when “Data Unavailable”.
9. Attributable Cases

D. Number of Cases Attributed to Transmission:

Please allocate the number of cases that you had this year by type in the fields below

Note: Put 'NA' when “Not Applicable” and 'DU' when “Data Unavailable”.
10. Attributable Cases

D.Number of Cases Attributed to Services:

Please allocate the number of cases that you had this year by type in the fields below

Note: Put 'NA' when “Not Applicable” and 'DU' when “Data Unavailable”.
11. Survey Respondent Information
12. Please feel free to enter any comments you have regarding APPA's safety contest.
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