SAFEty and Health Committee Award Nomination Form

This award goes to a workplace safety and health committee that takes an active role in improving health and safety in their workplace. The committee members work as a team to spread safety and health messages and to resolve safety and health issues that arise. The committee’s activities strengthen their workplace’s culture of safety.

Nominations for the SAFEty and Health Committee Award will be accepted from anyone in the workplace who is not a member of the committee.

Please complete the following form to nominate your workplace committee for the SAFEty and Health Committee Award. We ask that you review our compliance criteria to make sure your nominee is eligible.

SAFEty and Health Committee Award Nomination Form

"*" indicates required fields

Which committee are you nominating?

Committee name*

Workplace name*

Employer co-chair's name*

Worker co-chair's name*

Workplace address*

City*

Postal code*

Nominator information:

First name*

Last name*

Job position*

Workplace name*

Workplace address*

City*

Postal code*

Phone number*

Email*

Why are you nominating this committee for a SAFEty and Health Committee Award?

Please answer these four questions to show how your committee meets the requirements for this award.

What has this safety and health committee accomplished to earn a nomination for a SAFEty and Health Committee Award?*

(max. 200 words)

Please give at least one example of how the safety and health committee's members worked as a team to spread safety and health messages in the workplace effectively.*

(max. 200 words)

Please give at least one example of how the safety and health committee's members worked as a team to resolve a safety and health issue in the workplace.*

(max. 200 words)

Please give at least one example of how the safety and health committee's members worked as a team to resolve a safety and health issue in the workplace.*

(max. 200 words)

SAFEty and Health Committee Award Nomination Form