Company Name *

Policy Number *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Contact Name *

Title *

Phone *

Your Email *

Please briefly describe your primary business operation. *

How many employees work for your organization? *

What role does safety play in your organization’s culture? *

What are some of the workplace safety concerns unique to your industry? *

What practices have you added to your program that helped improve your safety record? *

What impacts or benefits have you seen resulting from a strong safety program? *

How has KEMI assisted in enhancing workplace safety and reducing claims? *

What notable safety milestones or recognition has your organization achieved during the past several years? *

Please share any additional information you feel would be helpful in the evaluation of your organization’s safety performance.

2023 Destiny Award Application