IMWCA Safety Study Implementation Grant - Iowa Municipalities Workers' Compensation Association

Organization

Contact Name

First Last

Contact Email

Mailing Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Total Number of Employees

*Summer Seasonal Employees Do Not Qualify

Hazards to be Addressed in Application (please check all that apply)

Other Hazard To Be Addressed

Total Amount Requested

Tell Us About Your Issues

Briefly describe the nature of the issues including a description of what training and services will be implemented. Be sure to state how you plan to implement your project and the long term goal.

What Are Your Implementation Goals

Identify and describe the injury history of the targeted occupation(s) (if any), or preventative safety issues you intend to address in this proposal. Connect the safety training and implementation with the work the employee performs.

IMWCA Safety Study Implementation Grant Application