1. 2017 Safety Leader of the Year nomination

 

Deadline for application is July 6, 2017

* 1. Name of the person being nominated

* 2. Job Title

* 3. Employer

* 4. Address of Employer

* 5. Phone number of the person you are nominating

* 6. Email address of the person you are nominating

* 7. Does the nominee have related certifications? Please identify, if any.

* 8. Overall, why do you think this nominee should be the next Safety Leader of the Year?

* 9. What leadership skills does this nominee demonstrate? How does he/she "walk the safety talk"?

* 10. Name some of the nominee's significant accomplishments in promoting health and safety in the organization.

* 11. Describe a particular project or initiative this nominee has initiated/developed/implemented, and how this helped raise the culture of safety in the organization. (You can choose to describe more than one initiative here if you wish.)

* 12. Describe the nominee's commitment to health and safety outside of his/her own organization.

* 13. What is your name?

* 14. Please provide your e-mail.

* 15. Please provide your phone number.

* 16. The winner will need to participate in a phone interview, video filming and photo shoot for COS magazine and website. Is the nominee (and the nominee's company) willing to do so if he/she is the winner?

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