Endorsement Form

The BGC® Impact Award is awarded to a Certified Industrial Hygienist® or Certified Associate Industrial Hygienist® who has made a significant contribution to the practice of occupational and environmental hygiene.

Note:  This form is for the endorsement of a previously-nominated candidate for the CIH Impact Award.  If you are looking for the Nomination Form for the Impact Award, please click here:  Impact Award Nomination Form.

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* 1. Nominee’s Information (the person who has already been nominated)

Briefly describe the Nominee’s Occupational and Environmental Hygiene accomplishments, work, and contributions which resulted in a significant impact on the profession in the last five (5) years.

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* 2. Written Justification

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By typing my name below, I certify that the above information is true and accurate to the best of my knowledge.