1. Contractors Safety Information Sheet Presented by: Matt Hodge, KBR Houston Business Roundtable 2011 Safety Excellence Award Training

2. Houston Business Roundtable 2011 Safety Excellence Award Training  Six Sections  Nominated By  Name of Firm  Type of Business  Company Description  OSHA Information  Contact Information

3. Nominated by: ABC Chemicals *Note: If your firm has received several nominations, copy this form and complete one for each project site  Fill out one form for each project site you have been nominated for. Section 1: Nominated By

4. Name of your firm exactly as you wish it published on any brochures, plaques, etc.: Contact Name:Title: AddressCity/State/Zip Phone:Fax:e-mail:  Name of company as you would like to see it on awards.  Contact name needs to be someone that can answer questions. Section 2: Name of Firm

5.  Check the category for which you want to be considered. Section 3: Type of Business

6. Company Description (Type of work/service your company does) _______________________________________________________________________________ _______________________________________________________________________________  Need a good description of work/service your company performs. Section 4: Company Description

7.  Data needed for both: Nominated worksite. Total company (All work in the US) Section 5: OSHA Information

8.  Contact name needs to be someone that can answer questions.  Make certain contact information is correct. Section 6: Contact Information

9. Safety Awards Initial Evaluation Form Houston Business Roundtable 2011 Safety Excellence Award Training

10. Houston Business Roundtable 2010 Safety Excellence Award Training Consist of a four page document

11. Safety Awards Initial Evaluation Form  Six Sections  General Information  Safety, Health & Environmental Performance  Safety, Health & Environmental Management  Safety, Health & Environmental Programs/Procedures  Safety, Health & Environmental Training  Information Submittal

12. Section 1: General Information GENERAL INFORMATION 1.Company Name:Telephone: Fax: Street Address: Mailing Address: Web site: Contact Person: e-mail: Telephone: Fax: 2. Parent Company Name:  Once again double check contact information.

13. Section 2: Safety, Health & Environmental Performance

16. Section 3: Safety, Health & Environmental Management

17. Section 4: Safety, Health & Environmental Programs/Procedures

27. Section 5: Safety, Health & Environmental Training

28. Section 6: Information Submittal  Provide copies of checked items applicable to your company’s work.

29. Section 5: Information Submittal Need name and title of Company Officer responsible for accuracy of this document. Don’t forget to include your company’s actual Best Practice

30. Overview Fill out Contractor Information Sheet for each project site that nominated you. Complete the Safety Awards Initial Form. Need copies of checked items applicable to your company’s work either: Electronic Copies (Disk) Hard Copies NO EMAILS OR FAXES! (Will not be accepted)

31. Overview Continued If submitting a disk make sure: Content is organized. Can open all material with a common program. Need hard copies of Information Sheet and Initial Evaluation Form with the disk.

32. Overview Continued Please submit all Information by: Hand delivering or, Mailing to: Houston Business Roundtable 8031 Airport Blvd. Suite 118 Houston Texas, 77061 By: 4:00 PM Monday, January 31, 2011 NO EXCEPTIONS!

33. Houston Business Roundtable 2011 Safety Excellence Award Training