Application for Designation

Smart About Salt Certified Contracting Company

Enter a User name: Enter a Password: Company Operating Name (to be listed on SAS website) Company Legal Name (if different from above) Address City Postal Code Province Phone FAX Company Website URL Designated Company Agent Agent Title Contact E-mail Address Winter Season Dates From:         To:      On behalf of our company I declare that we have completed the application requirements of the Smart About Salt program listed below: We are committed to improving our salt management and the use of best practices to uphold the principles of the Smart About Salt program. We shall encourage all facilities we work with to become Smart About Salt certified. We understand and agree that our Annual Certification Report is subject to verification by audit. We understand that failure to submit an Annual Certification report will result in the loss of our designation as a Smart About Salt Certified Contracting Company. Salt Use Summary If known, enter your application rates OR use the Salt Application Calculator to compute the rate. High Rate:    grams/sq. meter pounds/sq. foot   Medium Rate:    grams/sq. meter pounds/sq. foot   Low Rate:    grams/sq. meter pounds/sq. foot   SALT APPLICATION CALCULATOR Total Salt Used: (Based on your site surveys) No. of Events:  (A winter event is any visit to a site that requires salt to be applied to the entire site.) Total Salt Used: (Based on your site surveys)    Paved Area:       Walkways Area:       Square Feet Square Yards Square Meters Acres Hectars    Total Area:       Total Amount:     Pounds Kilograms Cubic Yards Cubic Meters Cubic Feet Tonnes Application Rate: Grams/Square Meter Avg.Application Rate: Grams/Square Meter/Event

Self-Assessment Summary SAS Contractors are required to demonstrate continuous improvement in their winter operations. They must show that they are serious about improving the rating of their activities using the Self Assessment Worksheets. The following table must be completed and submitted annually. These ratings are based on the information in the Smart About Salt Training manuals. View/Print Self-Assessment Work Sheet Practice N/A Current Rating Target Rating Target Year Action plan     Getting a Handle on the Amount of Material Used Equipment Calibration 0 1234 0 1234 2013 2014201520162017201820192020   Material Application Rates 0 1234 0 1234 2013 2014201520162017201820192020   Material Usage Record 0 1234 0 1234 2013 2014201520162017201820192020       Reducing an Operations Impact on the Environment Use of Liquid Materials 0 1234 0 1234 2013 2014201520162017201820192020   Use of Low or Non-chloride Materials 0 1234 0 1234 2013 2014201520162017201820192020   **Winter Season Salt Storage 0 1234 0 1234 2013 2014201520162017201820192020   Liquid Storage 0 1234 0 1234 2013 2014201520162017201820192020   Material Storage over Summer 0 1234 0 1234 2013 2014201520162017201820192020       Operational Improvements and Basic Storm Response Plowing Operations 0 1234 0 1234 2013 2014201520162017201820192020   Salt Management Training 0 234 0 234 2013 2014201520162017201820192020        *Your Action Plan is a brief summary of your plans to improve operations from one year to the next.    **Enter a 4 in Current and Target Rating if you DO NOT store salt.

Certification Compliance Report SAS Contractors are required to demonstrate continuous improvement in their winter operations. They must show that they are serious about improving the rating of their activities using the Self Assessment Worksheets. The following table must be completed and submitted annually. These ratings are based on the information in the Smart About Salt Training manuals. Training SAS Contracting Companies are required to train their operators in best salt management practices. Do you have an internal salt management training program that is consistent with the Smart about Salt learning goals? Yes    No Number of employees and subcontractors that apply salt in your operations Number of employees and subcontractors that have completed Smart about Salt Training Number of employees and subcontractors that have completed internal training Record Keeping SAS Contractors are required to use a Daily Winter Log, a Site Information Sheet and a Supervisors’ Log that are consistent with the sample forms provided. You may upload your logs by clicking the appropriate "Browse" button. Daily Winter Control Log Site Survey Sheet Supervisors’ Log Calculating Areas and Amounts Calculating Areas and Amounts Calculating Areas and Amounts Yes    No Treatment areas and salt application amounts have been calculated for each site Yes    No All supervisors and operators are trained in determining and controlling the appropriate amount of salt applied at each site under their control. Yes    No Records of salt applied at each site are maintained Yes    No Declaration I declare that the information in this SAS Annual Certification Report is accurate and was supplied voluntarily. I recognize that the Smart about Salt sample materials are to be used as a guideline only and release the Smart About Salt Council, its licensees and its employees and agents from any liability resulting from the completion or implementation of the Smart About Salt program. I have the authority to bind the organization. Name Position Address Phone    FAX   E-mail