Safety Excellence Award Form - Indiana WEA

Safety Excellence Award Form

Award Applications must be submitted no later than February 22, 2019, for consideration of awards. Applications received after February 22, 2019, may potentially not be considered for either safety award. Once your application has been received, the committee will forward the self-audit form for review so you will know what to expect during the audit process. Burke Award applicants will also receive an additional request form to gather additional information prior to the audit process. Facilities applying for either award must be accessible for the auditor within a reasonable time frame and be able to accommodate the schedule of the volunteer.

  • If same as above, please leave blank.
  • Due to the number of facilities requesting inspection, it is important for the safety committee to recruit new volunteers for the Safety Committee and auditing of facilities. Please check below if you are willing to help conduct safety audits for the safety committee. It will be noted if your facility is applying for the Burke Award, you will not be assigned to conduct any Burke Award audits.