Strategic Safety Program of the Year Nomination Form

Does your district have an initiative, project, or program designed to improve the safety of your workplace? We want to recognize the strategic vision of Pool members who want to ensure that every employee goes home safely. Use this form to nominate your district's program so that we can recognize you and share your success with other members of the Pool.

The winner for the year will be announced at the SDA Annual Conference.

For more information about this program including terms and guidelines, please visit our webpage.

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* 1. Nominator's Information

Contact Name

District

Title

Address

City/Town

State

ZIP Code

Email Address

Phone Number

Strategic Safety Program of the Year Nomination Form

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* 1. Nominator's Information

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* 2. Please provide the name of your safety program (if applicable) and a brief description.

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* 3. Describe the problem or circumstances that led to the undertaking of this program.

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* 4. What makes your program unique and innovative?

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* 5. Identify the value that has resulted from this program. What cost savings have their been?

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* 6. What other positive results have their been as a result of this program?

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* 7. How can this program be adapted for other districts? Who else may benefit by using this program?