Nebraska's Safest Companies Application

First Name*

Last Name*

Job Title*

Email Address*

Company Name*

We have established a Pandemic Coordinator who will be responsible for Covid-19 issues and their impact on our workplace.*

See item #1, pg. 2 on Workplace Assessment document.

Yes

We have identified where and how workers may be exposed at work.*

See item #2, pg. 2 on Workplace Assessment document.

Yes

We have completed a Risk Assessment of our workplace.*

See item #3, pg. 2 on Workplace Assessment document.

Yes

We will continue to stay informed of all local, state, and national developments.*

See item #4, pg. 3 on Workplace Assessment document.

Yes

We will notify the local health department about confirmed/suspected cases of Covid-19.*

See item #5, pg. 3 on Workplace Assessment document.

Yes

We will educate our employees about how they can reduce the spread of Covid-19 using CDC guidelines.*

See item #6, pg. 3 on Workplace Assessment document.

Yes

We will encourage our employees to stay at home if they are sick or have been exposed to Covid-19.*

See item #7, pg. 3 on Workplace Assessment document.

Yes

We will monitor all employees and outside vendors to ensure we maintain a safe environment.*

See item #8, pg. 4 on Workplace Assessment document.

Yes

We will continue to maintain healthy business operations, including management of staff absenteeism, sick leave and other emergency policies pertaining to Covid-19.*

See item #9, pg. 4 on Workplace Assessment document.

Yes

We will develop and reinforce policies and practices for social distancing, hand-washing protocol and respiratory etiquette.*

See item #10, pg. 5 on Workplace Assessment document.

Yes

We will perform routine environmental cleaning and disinfection in employee workspaces, meeting/gathering rooms and provide additional information to employees that may be required to travel for their jobs.*

See item #11, pg. 6 on Workplace Assessment document.

Yes

We will establish a healthy work environment through Engineering or Administrative controls and/or use of Personal Protective Equipment (PPE) using OSHA guidelines.*

See item #12, pg. 7 on Workplace Assessment document.

Yes

We will focus on best practice guidelines set forth through the CDC and OSHA including increased training and communication to all of our staff, customers and business partners.*

Yes

We will follow the mantra “Safety without Shortcuts” because we know the importance of keeping all Nebraskans safe.*

Yes

City, State*

Zip Code*

Phone Number (with area code)*

Company URL