APPLY Application Company Name * First Name * Last Name * Job Title * Email * Phone * Website/URL * Headquarters Address * Headquarters Address Headquarters Address Headquarters Address City City State/Province State/Province Zip/Postal Zip/Postal Country AfghanistanAland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBruneiBulgariaBurkina FasoBurundiCôte d'IvoireCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCook IslandsCosta RicaCroatiaCubaCuracaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland Islands (Malvinas)Faroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestinePanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarReunionRomaniaRussiaRwandaSaint BarthelemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint Martin (French part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint Maarten (Dutch part)SlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUnited States Minor Outlying IslandsUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Country Organization Type * Academic/Government Lab Early-Stage Startup (Seed) Mid-Stage Startup (A or B) Commercial Startup (C+) Small-to-Medium Corporation Corporation Number of Employees * < 19 20-99 100-499 500-2499 2500 < Ownership Woman Owned Minority Owned Veteran Owned Technology Maturity * Conceptual Lab-Scale Piloted with External Partner Ready for Commercialization Commercially Available Type of Technology * Software Wearable Mobile Application Hand-Held Device Geofence Flow Interrupters Communications Technology: Immediate Vicinity Communications Technology: Remote Notifications OtherOther Primary Technology Focus Area * Detection of hazardous energy risks in the workplace Securing hazardous energy risks in the workplace Communication of locked out hazardous energy risks to workers in the immediate vicinity Communication of locked out hazardous energy risks or discharges to safety professionals Provide a brief summary of your technology. * 0 of 100 max words Indicate the hazardous energy your technology addresses. * Chemical Electrical Hydraulic Mechanical Pneumatic Thermal All of the Above Provide an overview of your technology. Describe what it does and how it controls hazardous energy in the workplace. * 0 of 300 max words Describe the impact your technology could have on a workplace environment. * 0 of 250 max words i.e. numbers of injuries/fatalities prevented, reduction in lost work hours What industries or occupations would benefit most from the use of your technology and why? * 0 of 250 max words Summarize the available evidence demonstrating the effectiveness of your technology. * 0 of 250 max words Describe the key members of your team and the experience they bring to your organization. * 0 of 250 max words What makes your technology unique, compared to alternatives? * 0 of 200 max words Describe the pilot test you envision with an external partner. * 0 of 250 max words i.e. who the partner is, what the pilot would entail, when it could be conducted Are you a current member of the NSC TechHub Marketplace? * Yes No If you have a video demonstration of your technology, link to that recording here. If you have letters of support from external partners, upload them here. Drop a file here or click to upload Choose File Maximum file size: 2.1MB If you have a product brochure for the technology, upload it here. Drop a file here or click to upload Choose File Maximum file size: 2.1MB If you have additional evidence of effectiveness of the technology, upload it here. Drop a file here or click to upload Choose File Maximum file size: 2.1MB Submit If you are human, leave this field blank.
