2023 STI/SPFA Safety Awards

Please complete this form to apply for an STI/SPFA Safety Award. All fields are required.

Select the award(s) you are submitting for:
Check applicable employer size:

Contact Information - Person responsible for maintaining records of workplace injuries and illnesses for MEMBER EMPLOYER, and to whom plaque and hardhat decals (see below) should be sent.

Contact Information - Person responsible for management of this MEMBER EMPLOYER facility:

Select the type of recognition you would like (choose only one):(Required)
Decals are provided at a cost of $0.60 ea. plus shipping, and are invoiced at the time of shipment. Unless otherwise indicated, the plaque and hardhat decals will be shipped to the individual named above as recorder of workplace injuries and illnesses for the member employer facility.
By submitting this form you certify that all information is factual and true for the member employer, and if asked, can provide verification of this information.(Required)