Stand Up 4 Grain Safety Week

Recognize Your Participation

Thank You for participating in Stand Up 4 Grain Safety Week!

Complete the form below to tell us about your participation and receive a Certificate of Participation. The Certificate is a fillable PDF file that can be downloaded and filled in with your name and the names of your employees to individually acknowledge the participation of everyone on your team.

Note: The PDF file does not automatically insert names after submitting this form.

Recognize Participation for 2022 Stand Up Week

Company Contact Person*
First Last
Email*
Company Name

Providing the company name is optional, but it helps the Alliance determine the reach and effectiveness of the Stand Up4Grain Safety Week, as well as gain insight into areas current outreach efforts may be missing.
Address
City State / Province / Region ZIP / Postal Code Country

This is optional. Consider providing the city and state so we can see how many places participated in the Stand Up for future planning purposes.
Tell Us Who Participated
How many facilities (locations) participated in your company's Stand Up 4 Grain Safety Week?
This is optional information. Companies with several locations and a central Stand Up coordinator may want to share how many of their locations participated.
How many people participated in the training event at your location?*
Was there a diverse group of participation?
- Select All
- Managers/Supervisors
- Workers
- Contractors
- Temporary Workers
- Producers/Farmers
This is optional. It helps us understand who is participating in Stand Up 4 Grain Safety Week and how to better plan for the future.
Tell Us About Your Event
Help us understand what others are doing for Stand Up 4 Grain Safety Week and what your employees liked for future planning. This section is optional.
Type(s) of Event
- Select All
- Demonstration / Presentation
- Guest Speaker
- Safety Topic Discussion
- Training
- Other
Please specify other event type(s).
How has participation in Stand Up Week impacted your company?
Stand Up Photos

Upload your Stand Up photos if you choose.
File
Max. file size: 100 MB.

Recognize Your Participation

Thank You for participating in Stand Up 4 Grain Safety Week!

Recognize Participation for 2022 Stand Up Week

Tell Us Who Participated

Tell Us About Your Event