I. WORKPLACE SAFETY MERIT AWARD

This award is given to MEMBER organizations showing an Experience Modification Rate* (EMR) of 1.0 or below for 2024.

CRITERIA

A. The awards will be based on an EMR of 1.0 or below.
B. Applicant must submit documentation from ND WSI verifying their EMR. If your organization is too small for WSI to calculate your EMR, call us to discuss other qualifications.

*WSI refers to this as Experience Modifier (MOD) and industry terminology is Experience Modification Rate (EMR). Note that this should be a decimal number not a percentage.

Reporting as:

Workplace Safety Merit Award reporting as*

Entire Company

Separate Plant or Division

Separate Plant or Division Name (if applying as separate plant or division)

NDSC Member Company Name (as it will appear on award)*

2024 EMR Rating*

First Name*

Last Name*

Job title

Street address*

Street address 2

City*

State/Province*

Postal code*

Phone Number*

Email*

Notes or Supporting Documentation
(Optional)

File upload

Upload .pdf, Word or Excel file types only

Workplace Safety Merit Award Notes

limited to 3,000 characters