FY16 SAFETY GRANT APPLICATION AND INSTRUCTIONS.pdf

The Commonwealth of Massachusetts

Executive Office of Labor & Workforce Development

Department of Industrial Accidents

FISCAL YEAR 2016

WORKPLACE SAFETY

TRAINING & EDUCATION GRANT PROGRAM

REQUEST FOR GRANT APPLICATIONS

Linda Edmonds Turner

Director

1 CONGRESS STREET, SUITE 100

BOSTON, MA 02114-2017

IMPORTANT: Prior to completing or submitting a Safety Training Grant application, please be sure that you are using the most current version of the application available. Visit http://www.mass.gov/lwd/workers-compensation/safety to download the current application or email safety@dia.state.ma.us http://www.mass.gov/lwd/workers-compensation/safety mailto:safety@dia.state.ma.us

APPLICATION PROCESS

Safety Training Grant applications will be accepted beginning on May 26, 2015. Companies and organizations are encouraged to apply as soon as possible to have the maximum practical opportunity for funding.

Completed Applications will be evaluated beginning June 23, 2015 and reviewed until February 26, 2016.

If the number of qualified applicants exceeds funding availability, subsequent applications will continue to be routinely accepted and evaluated and those that qualify will be placed on a waiting list as funding becomes available.

Strong preference will be given to employers and organizations who demonstrate a compelling program design that addresses an injury history, potential injury or provides a proactive approach to injury prevention.

Timetable for funding is determined by the fiscal year, therefore, all training must be completed on or before June 30, 2016.

The Office of Safety reserves the right to only consider submissions that, in our sole judgment, are complete and responsive to the requirements and include all application components.

GRANT OVERVIEW

The prevention of occupational injury and illness is in everyone’s best interest. This Grant entitled, “Workplace Safety Training and Education Grant Program” is issued under the provisions of the

Massachusetts General Law, Chapter 23E, Section 3, and administered by the Department of Industrial

Accidents Office of Safety. The goal of this program is to promote safe and healthy conditions in the workplace through training, education, and other preventative programs, for employees and employers covered by the Massachusetts Workers’ Compensation Law, (M.G.L. Ch. 152).

The Department of Industrial Accidents (DIA), through the Office of Safety awards up to $25,000 to qualifying employers and is the only State agency in the Commonwealth of Massachusetts whose primary function is to provide financial assistance for the prevention of occupational injury, illness, and death in the workplace.

Applicants must be in full compliance with all obligations to the Department of Unemployment

Assistance, Department of Industrial Accidents, and any other obligations to the Commonwealth of

Massachusetts. Applicants found to be non-compliant will be removed from consideration until all compliance issues have been resolved.

GRANT CRITERIA

The Office of Safety will fund programs which target education/training programs for employees and/or employers operating within the Commonwealth of Massachusetts and whose entire staff, vendors, and training providers are covered by the Massachusetts Workers’ Compensation Law (M.G.L. Chapter 152).

The Office of Safety will verify your current coverage. If you are exempt from Workers’ Compensation

(e.g. sole proprietorship, DBA, self-insured) please provide a letter explaining your exemption in the application. Applications from entities that are found to be non-compliant with the statute will be removed from consideration.

Periodic review(s) of workers’ compensation policies may be made after grant approval to ensure workers’ compensation policies are current. If a grantee allows their workers’ compensation policy to lapse during the grant cycle, the grant will be suspended or revoked at the discretion of the Office of Safety.

If you are training additional affiliated partners or associated businesses in your proposal not covered by your Workers’ Compensation policy, they need to be identified at the time of application for approval.

Grants are intended to fund Massachusetts based employees and Massachusetts based training providers.

Safety training grants are capped at a maximum of $25,000 and grants will be limited to (1) grant per entity per fiscal year.

Training costs must be submitted on a PER CLASS OR PER PERSON BASIS ONLY. Applicants should review the costs of instruction and related training materials with vendors to ensure the proposed costs are reasonable and effective. Reimbursement will be based solely on your submitted budget summary at the time of application.

Greater weight will be given to all inclusive programs, those that incorporate the cost of all training materials and certifications where practical.

The Office of Safety will examine submissions for cost effectiveness and will be the final determiner in assessing appropriate costs and standards for training and training materials.

All costs associated with this grant must be concluded before June 30, 2016. All invoices for services or materials must be received by the Department of Industrial Accidents on or before

July 31, 2016

Administrative costs will be limited to up to seven (7) percent of the total amount expended and will not be paid until the final report is received, no later than July 15, 2016

Vendors, safety training companies and other providers are prohibited from charging a fee or receiving additional compensation for safety training services or materials specifically provided by this grant.

The Office of Safety will conduct regional workshops with approved grant recipients to review related administrative tasks including invoicing, sign in sheets, reimbursement and scheduling.

The Office of Safety reserves the right to meet with the grant recipient for the purposes of ensuring program compliance and to consider other criteria within the scope of the eligibility requirements in making competitive awards among comparably qualified applicants.

Training providers are prohibited from subcontracting training services to another provider.

Training schedules must be submitted within 90 days from the date of approval

GRANT EXCLUSIONS

THE PRIMARY PURPOSE OF THIS GRANT IS TO PAY FOR ACTUAL TRAINING AND

COST OF ASSOCIATED MATERIAL ONLY

Applications from State Agencies or applications providing training to State Agencies will not be accepted. We cannot fund employees of the Commonwealth who provide training services during the normal course of their employment.

Online training programs that require online testing, completion or certifications

Programs that re-train employees previously trained by DIA Office of Safety grants on the same topic

Travel expenses (hotel, airfare, meals, car rental, tolls, mileage etc.)

Employee wages, stipends or fringe benefits

Costs incurred prior to contract approval

Training/education of a target audience which does not directly address the avoidance and prevention of unsafe and unhealthy working conditions and practices

Seminars that are not considered safety training

Programs primarily intended to promote membership in the recipient organization

Office space, conference room rentals, utilities, communications, equipment (TVs, DVD players, computers, projectors, etc.) or overhead expenses

No film production expenses

Copying and postage costs

Set up & break down

APPLICATION INSTRUCTIONS

** PLEASE REVIEW THIS PAGE CAREFULLY AS SOME REQUIREMENTS HAVE CHANGED

Please provide all of the information requested according to the instructions below. All grant applications along with supporting documents must be sent electronically to electronic.safetygrant@dia.state.ma.us

Applicant Organization Name Please use the organizations full legal name as registered with the

Secretary of the Commonwealth of Massachusetts.

Grant Administrator This person does not necessarily have to be the senior-most person at your facility, but should be an employee that is familiar with the application. The Grant Administrator will be sole person responsible for the coordination of the grant to include; training schedules, invoices, sign in sheets, budget modifications and trainer changes and respond to phone calls and/or e-mails regarding the grant application. The Grant Administrator must ensure that the work is carried out in accordance with the

Office of Safety standards, policies, and procedures to ensure smooth implementation. The Grant

Administrator has the responsibility to ensure that documents and legal agreements are prepared following the Commonwealth’s policies and procedures.

Address, Phone & E-mail These fields should be completed referencing the Grant Administrators information as the grant administrator will be the point of contact for all correspondence with the Office of Safety and the Executive Office of Labor and Workforce Development Contracts and Procurement

Unit as they relate to the grant application and contractual documents.

Federal Employee ID Number This number refers to the FEIN issued by the Internal Revenue Service.

Type of Organization For-Profit or Non-Profit Check whichever box applies.

SOMWBA Certified Certification is the process by which the Supplier Diversity Office (SDO) an agency within the Commonwealth of Massachusetts, formerly known as State Office for Minority and

Women Business Assistance (SOMWBA) helps promote the development of business enterprises and non-profit organizations owned and operated by minorities and woman.

Employee Demographics Total number of current employees within your organization and number of employees being trained for this grant.

Hazards to be addressed Check all hazards that apply

Location Demographics Check all county locations training will take place

Total Amount of Requested Total dollar amount requested including administrative costs.

Signature/Title Authorized Official or Grant Administrator (electronic signature will be acceptable) mailto:electronic.safetygrant@dia.state.ma.us

CONTRACTUAL REQUIREMENTS

Contractual Documents Must be fully completed and are required for submission. Original contractual documents and detailed highlighted instructions are available for download from our safety email address safety@dia.state.ma.us.

i. Commonwealth of Massachusetts Standard Contract Form:

ii. Commonwealth Terms and Conditions Form:

iii. Request for Taxpayer Information Number and Certification (W9)

iv. Contractor Authorized Signatory Listing (CASL):

v. Contractor Authorized Signature Verification Form (CASV):

vi. Commonwealth of Massachusetts Authorization for Electronic Funds Transfer

Payments (EFT)

vii. Department of Revenue Certificate of Good Standing

Certificate of Good Standing a Certified Copy of a Certificate of Good Standing (CGS) from the

Massachusetts Department of Revenue (DOR) that is less than six months old must be provided by applicants prior to consideration for grant awards. You can obtain the certificate at the DOR website http://www.mass.gov/dor and type “Certificate of Good Standing” in the search box.

COMMBUYS Registration The Operational Services Division (OSD) has provided a series of

COMMBUYS job aids and on-line learning videos for use as you transition to COMMBUYS.

COMMBUYS registration is easy! It takes just two simple steps:

1. Go to the COMMBUYS landing page at www.COMMBUYS.com.

2. Select the first link titled REGISTER and complete registration. There is no cost.

3. You must register and select the United Nations Standard Products and Services Code

(UNSPSC) 84-10-16.

Compliance Applicants must be in full compliance with all obligations to the Department of

Unemployment Assistance, Department of Industrial Accidents, and any other obligations to the

Commonwealth of Massachusetts.

**If you have questions or need assistance with the contractual portion of the application, please contact Diane Lentini at 617-626-5913 or via email dlentini@detma.org

ONLY ORIGINAL CONTRACTUAL DOCUMENTS WILL BE ACCEPTED VIA US POST OR

SIMILIAR SERVICE TO:

Department of Industrial Accidents

Office of Safety

One Congress St. 10 th Floor

Boston, MA 02114

617-727-4900 safety@dia.state.ma.us http://www.mass.gov/dor http://www.mass.gov/anf/budget-taxes-and-procurement/procurement-info-and-res/conduct-a-procurement/commbuys/job-aids-for-sellers.html http://www.mass.gov/anf/budget-taxes-and-procurement/procurement-info-and-res/conduct-a-procurement/commbuys/training-and-registration-for-sellers.html https://www.commbuys.com/bso/ mailto:dlentini@detma.org

GRANT APPLlCATION/SUPPORTING DOCUMENTS CHECK OFF SUMMARY

Prepare and submit the application according to the following outline: Grant applications and supporting documents must be submitted electronically as ONE attachment. Multiple attachments and zip files

WILL NOT be accepted.

YOUR APPLICATION MAY NOT BE REVIEWED IF ANY OF THE FOLLOWING

DOCUMENTS ARE NOT INCLUDED.

Grant Application- All questions must be answered

Organization Description, Needs Assessment, Proposed Training Summary

Budget Narrative

Budget Summary

Qualifications of training providers

1. Key Personnel resumes or Biographical Profile

2. Current certifications and or licenses

Certificate of Good Standing from the Department of Revenue (DOR)

Contractual Documents (only ORIGINAL CONTRACTUAL documents can be accepted)

If you have questions or need assistance with the application please contact The Office Safety

Maria Pesantes Deven Awalt

Program Coordinator Compliance Officer

617-727-4900 ext. 7376 617-727-4900 ext. 7404 maria.pesantes@state.ma.us deven.awalt@state.ma.us

Only Completed Grant Applications must be sent electronically to:

electronic.safetygrant@dia.state.ma.us mailto:Maria.pesantes@state.ma.us mailto:deven.awalt@state.ma.us mailto:electronic.safetygrant@dia.state.ma.us

COMMONWEALTH OF MASSACHUSETTS

DEPARTMENT OF INDUSTRIAL ACCIDENTS

OFFICE OF SAFETY

WORKPLACE SAFETY

TRAINING & EDUCATION GRANT PROGRAM

COMPANY INFORMATION

1. Applicant/Organization Legal Name:

2. Grant Administrator /Title:

3. Applicant Address:

4. Phone Number:

5. Email Address:

6. Federal Employer Identification Number (FEIN)

7. How did you originally hear about this grant program?

8.

9.

Type of organization For-Profit Non- Profit

Is your company or training provider SOMWBA certified? If yes please specify.

10. Employee Demographics Total Employees Total Employees To Be Trained

Hazards to be addressed in application (please check all that apply)

OSHA

Ergonomics

CPR/AED

Injury Prevention

Fire/Electrical

Stress

Asbestos

CTD’s

Other (explain)

Lead Hazards

Toxins

Right to Know/Hazard Communication

12. Location Demographics: Which counties will training take place (please check all that apply)

Barnstable

Essex

Middlesex

Suffolk

Berkshire

Franklin

Nantucket

Worcester

Bristol

Hampden

Norfolk

Statewide

Dukes

Hampshire

Plymouth

13.

Total Amount Requested

14. Signature /Title (electronic signature is acceptable)

ORGANIZATION DESCRIPTION

Briefly describe the nature of the applicant’s business including a description of products or services provided. Be sure to state how long your organization has been established and the number of employees.

NEEDS ASSESSMENT

Identify and describe the injury history of the targeted occupation(s) or preventative safety issues you intend to address in this proposal

TRAINING / CONTINUING EDUCATION

PROPOSED TRAINING SUMMARY

Provide a brief description of the proposed training plan.

BUDGET NARRATIVE

Provide a complete and itemized budget plan. This should be a detailed written description of how each line item in the Budget Summary will be utilized. Identify the number of participants to be trained, the number of training sessions, number of participants per session, the names of trainers providing services and number of instructors to be present for each session, training locations, training topic, and length of time per session. In order to evaluate the cost effectiveness of the program approximate projected class sizes are required.

BUDGET SUMMARY

COMPANY:

GRANT ADMINISTRATOR NAME:

ADDRESS:

PHONE:

E-MAIL ADDRESS:

DESCRIPTION CONTRACT EXPENDITURE #’S

COMPLETE ONE OPTION ONLY

CONTRACT EXPENDITURE COST

COMPLETE ONE OPTION ONLY

TOTAL COST

NAMES OF TRAINERS

OR

MATERIAL DESCRIPTION

TOTAL # OF

PEOPLE

TOTAL # OF

CLASSES

$COST PER

PERSON

$COST PER

CLASS

7% ADMIN COST

MAXIMUM OBLIGATION

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COPY RIGHT

Funded programs may be subject to an audit by the State Auditor’s Office or authorized officials of the

Commonwealth of Massachusetts. All books, records, and other compilations of data pertaining to the performance of the provisions and requirements of the contract to the extent and in such detail as shall properly substantiate claims for payment under the contract, must be maintained for a minimum of 7 years.

All published material, including without limitation, report, manuals, pamphlet, articles, etc., prepared by grant recipients with Office of Safety funds shall be created as a work for hire for the purposes of 17 U.S.C., Sections 101 et seq., and the DIA Office of Safety shall be the sole author and owner of the copyright. The selected applicant may distribute the materials subject to a nontransferable, nonexclusive, revocable license.

Any reproduction for distribution of these materials must prominently display on the front cover or in the beginning credits: “This (fact sheet, manual, video, etc.) was funded by the Massachusetts Department of

Industrial Accidents, Office of Safety. Copyright 2014/2015 by the Commonwealth of Massachusetts, Department of Industrial Accidents. The opinions and views expressed herein do not necessarily reflect those of the Massachusetts Department of Industrial Accidents. No reproduction or other use is authorized for this material without the express written approval of the Office of Safety.

At the time of training you are required to acknowledge the Department of Industrial Accidents, Office of

Safety as the funding source for the training being provided.

The Office of Safety may institute additional reporting requirements. All lead applicants will be notified of any changes to the reporting requirements.

The Office of Safety reserves the right to suspend or revoke the contract for funding at any time and for any reason.

It is the policy of the government that small, minority and women-owned business enterprises shall have the maximum practicable opportunity to participate in the performance of government contracts.

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