NOMINATION FORM - Electrical Contractors Association of Ontario

APPLICATION FORMR. H. (HUGH) CARROLL SAFETY AWARD (RATE GROUP 704 & 830)Recognizing and Encouraging Safety Amongst the Member FirmsOf the Electrical Contractors Association of OntarioMembers wishing to apply should fill out the following form and return it to the ECAOoffice to the attention of the R. H. (Hugh) Carroll Award Committee.The deadline for application is April 24, 2009Company Name:Address:Tel:Contact:Area ECA:Fax:Email:Group Rate 704 Group Rate 830Category (check one): Companies having not more than 50,000total work hours Companies having between 50,001 and200,000 total work hours Companies having between 200,001 and500,000 total work hours Companies having over 500,000 totalwork hours.Category (check one): Companies having not more than50,000 total work hours Companies having over 50,000 totalwork hours.Date Application SubmittedSignature of ContactIMPORTANTAll applications must be accompanied by most recent WSIB Account Profile,Health & Safety Program; and safety program audit results (if any). All WSIBAccount Profiles and other company safety data will be held in the strictest confidenceby ECAO. No details will be announced or published; except for the names of winnersin each category. The awards will be presented each year at the ECAO Annual GeneralMeeting commencing in 2000.Submit Applications to:R. H. (Hugh) Carroll Award CommitteeElectrical Contractors Association of Ontario460-170 Attwell Drive,Toronto, Ontario M9W 5Z5