MCAA Safety Statistics and Award Program 2019/2020

Company Name*
Size Category
Address*
Street Address Address Line 2 State ZIP Code
Phone*
Fax
Email*
Contact Person*
**THE INFORMATION YOU RECORD ON THIS SHEET WILL BE KEPT STRICTLY CONFIDENTIAL**
1: Number of Work Hours for 2019*
Record only those hours worked by your company's jobsite craft labor
2: Number of Fatalities 2019:*
Record all work related jobsite craft labor fatalities (Column G of OSHA Form 300A)
3: Number of OSHA Recordable Injuries in 2019:*
Number of jobsite craft labor injuries (Total of Columns G, H, I, & J of OSHA Form 300A)
4: Number of Lost Workday Cases in 2019:*
Number of jobsite craft labor Lost Workday Cases (Column H of OSHA Form 300A)
5: Number of Lost Workdays in 2019:*
Total number of Lost Workdays resulting from the Lost Workday Cases (Column K of OSHA Form 300A)
Fatality Incidence Rate
OSHA Recordable Injuries Incidence Rate
Lost Workday Cases Incidence Rate
Lost Workdays Incidence Rate