The PERMA Excellence in Risk Management Award
Nomination Form

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* 1. PERMA MEMBER NAME

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* 2. MEMBER CONTACT NAME AND TITLE

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* 3. CONTACT EMAIL/PHONE

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* 4. NOMINEE IS A(N)

Individual

Municipality

Municipal department

Municipal safety committee

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* 5. NOMINEE NAME

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* 6. WHY DO YOU BELIEVE THE NOMINEE DESERVES THIS AWARD?
Award winners should demonstrate innovation, outside of the box thinking, and/or creative use of resources in promoting a positive safety culture.

Write a brief statement below explaining what the nominee accomplished, how change was implemented, and its impact.