FFVA Mutual Safety Award Nomination

Thank you for your interest in nominating a company for the Commitment to Safety Award or Safety Achievement Award/Most Improved.
We are taking nominations from January 1 through March 31, 2021. Companies large and small are eligible. Nominate today!

Selection criteria for each award.

Commitment to Safety Award

• Loss Ratio under 20% for a minimum of 3 consecutive years with FFVA Mutual
• Improving Experience Modification factor (MOD rate) for each of the qualifying years
• Completes critical recommendations made by their FFVA Mutual safety consultant
• Attends FFVA Mutual training, live webcasts, web-based resources and other safety services through OSHA outreach or other sources
• Development and implementation of formal safety programs, self-inspection programs, incentive plans and safety committees

Safety Achievement Award/Most Improved

• Improving Experience Modification Factor (MOD rate) and declining loss ratio showing continuous improvement
• Attends FFVA Mutual training, live webcasts, web-based resources and other safety services through OSHA outreach or other sources
• Development and implementation of formal safety programs, self-inspection programs, incentive plans and safety committees

Please complete the information below and submit.

[Click here to print these details and link to nomination form]

Role Agency PartnerPolicyholderFFVA Mutual Employee

Nominator's Email

Nominator's First Name

Nominator's Last Name

Nominating Company/DBA

Why I'm Nominating

Company's Policy Number

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