8/7/2019 RMCMI Contractor Award Application

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The Rocky Mountain Coal Mining Institute3500 S. Wadsworth Blvd, Suite 211 Lakewood, CO 80235

Phone: 303/948-3300 Fax: 303/954-9004www.rmcmi.org mail@rmcmi.org

A 501(c)(3) Nonprofit Educational Association founded November 11, 1912 for members representing the coal industry

RMCMI Contractor Safety Award Application

If you would like to recommend an outstanding contractor for their safety performance during calendar year2010, please fill out the form below and submit to mail@rmcmi.org All applications will be reviewed andjudged by the awards committee with the winning recipients being recognized at the RMCMI Convention and

Annual Meeting. This form can be submitted by either a contractor or mine operator. A contractor is noteligible if they experienced a fatal or life-threatening event during the year.

1. Contractor (company name) to be recognized:_______________________________________________

2. Contractor contact: Name:_______________________________ Phone:_________________________

3. Indicate which category best describes the Contractors work:______Operational Support Services (development, mining, maintenance, reclamation etc) or

______Non Operational Support (Engineering, cleaning services, security, consulting etc)

4. Individual and company making recommendation: __________________________________________

5. Mine operator contact where contractor has worked: Name:_____________________ Phone:_________

Please fill out the information below to the best of your knowledge

Category Calendar year 2010

Number of contractor hours during the year

Average number of employees contractor has on site

Number of MSHA reportable injuries

Number of Lost-time injuries

Total lost work days

Does the contractor have a formal safety program in placeIs the contractor a current member of RMCMI (At the time of nomination, the

contractor does not have to be a member; however, have a discussion about beinga RMCMI member with them. Final award recipients must be members when the

award is presented)

Please include a discussion as to why this contractor should be recognized for their safety achievements. Thisarea is critical as it will be weighted very heavy in the selection process. Include items like innovative

practices, comprehensive training program, frequency of safety meetings, use of safety tools (stop work cards,life saving rules etc.) (Attach additional sheets if necessary):

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