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Ambassador Application - Year 1
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Ag Promotion Award
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New York Farm Safety Award Application
Fields marked with
*
are required
Farm Name
*
Farm Owner(s)
*
Address of Farm
*
Please include street or PO Box, city, state, zip
Phone # of contact at Farm
*
Email
Farm type
*
Number of Employees
*
Does your farm have (select all that apply):
*
Safety committee
Incentive/motivation program
Employee wellness program
Formal training/mentoring program
Safety inspection program
Hazard correction program
What is your farm's policy/philosophy regarding safety?
*
Please provide an example of your management's commitment to safety (please also provide key elements of your safety and health program).
*
Please provide 2 examples of ways your employees are encouraged to participate in the safety process.
*
Please provide a photo of your team
Other important file (photos of the farm, awards, etc.)
Name, title and email of person nominating
*
Submit