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Governor's Workplace Safety Award Application

We invite your organization to participate in the Governor's Workplace Safety Awards, which recognize Minnesota employers for excellence in safety. Winners are honored during the Governor's Safety Awards Ceremony at the Minnesota Safety & Health Conference in May.

In addition to providing injury data, you'll also complete the Safety Program Evaluation Scorecard. The scorecard was developed by a team of experienced safety professionals from organizations that are members of the Minnesota Safety Council. It measures progress in implementing a comprehensive safety program. The application is a secure page, and all information you provide is confidential. Your total points on the scorecard and your incidence rates will be calculated for you automatically. After submitting your application, you will receive a confirmation e-mail that will include your total points for the Safety Program Evaluation Scorecard.

Important information about reporting for offices, operations units or multiple units within an organization:

Entities that are office only, operations units or separate divisions within an organization must have 20 or more employees.

For multiple units within an organization: If you elect to submit separate applications for various establishments/branches within your organization, the reporting units must have twenty or more employees each and maintain their safety results separately within your organization. If you are submitting more than one application, be sure to enter a DISTINCT "Company Name" in each application, e.g. by adding the location or the function of the unit to your company name. (This is especially important if your divisions are at the same address.)

* Examples — how to distinguish by location and by function

Please review the additional important guidelines and information linked below before applying.

Choosing an NAICS code
Years of data required
Definition of DART cases and OSHA recordable cases
Formulas used to calculate incidence rates
About the Safety Program Evaluation Scorecard
Award categories and judging
If you have questions
Sample award application form


Application now closed.