The content of this application will be considered confidential and used solely to determine your firm’s qualifications. No purchase order and/or contract will be issued without an approved Safety Program Evaluation.

Please Note:

You may not save your information and come back to the application at a later time. Please double check that you have the required information (below) ready before starting the application.

Upon completion of this safety portion you will be directed to and will receive a link for the financial portion of this pre-qualification.

The Ruhlin Company complies with all regulatory standards and requirements outlined by OSHA and other relevant regulatory bodies. Some programs may exceed these regulations. All subcontractors must comply with all Ruhlin Safety programs/requirements which are available by clicking the links below.

• The Ruhlin Company Written Safety Program
• The Ruhlin Company Safety Manual

Workers’ Compensation EMR

We require independent verification of your EMR.

Please attach a copy of the endorsement page from your policy listing your EMR, a copy of the EMR Report from the Ohio BWC (this can be downloaded from their website), and/or have your insurance carrier or broker provide this information on their letterhead.

Safety Performance

Please provide your organization’s injury and illness data for the last three years including OSHA 300A/300 logs.

Fines/Citations/Legal Actions

(+ supporting documentation)

Third-Party Contractor Safety Evaluation Programs

If you are a registered contractor under IS Networld, Avetta, Vero or any other third-party contractor safety program evaluation, you will be required to list your account number.

Subcontractors

All Tiered Subcontractors must have completed this paperwork and have been approved by the The Ruhlin Company Safety Department.

Drug & Alcohol Testing

You will be required to provide information about your organization’s drug and alcohol program, if applicable.

Health & Safety Program

(+ supporting documentation)

If your organization has a written safety program or manual, please attach a copy of the “Table of Contents” page.

Accident/Incident Reporting, Investigation & Injury Management

You will be required to provide information about your organization’s process for immediate reporting, investigating and follow-up of incidents, near misses, equipment damage and occupational injuries.

Workforce, Health & Safety Training

(+ supporting documentation)
•  Site Safety Audit Form
•  Pre-Job Analysis Form
•  New Hire Orientation or SSE Employee process
•  Most recent copy of a documented employee safety training session