Nomination form

NOPSEMA, in conjunction with the Australian Energy Producers and the Australian Council of Trade Unions, are holding their inaugural HSR Awards.

Do you have an outstanding Health and Safety Representative who has excelled in their OHS duties? Please complete the below form to nominate them by COB Friday 14 February 2025.

You may nominate more than one HSR for the awards, please complete a new survey for each nomination.

The HSR Awards will recognise HSRs who excel in:

Continuous improvement – identification and implementation of improvements that reduce OHS risk
Advocacy – sets an example in advocating for OHS in the workplace
Leadership – promotes and demonstrates through their actions the importance of the HSR role
HSR nominee's details

Question Title

* 1. Name of nominee

Question Title

* 2. Nominee's job title

Question Title

* 3. Where do they work?

Your details

Question Title

* 4. Your name

Question Title

* 5. Your job title

Question Title

* 6. Your organisation

Question Title

* 7. Which criteria has the nominee met to support their nomination for an HSR Award?

Question Title

* 8. Please provide more detail on how this HSR has met the criteria you selected in Q7

Thank you for your nomination. Award winners will be announced at NOPSEMA's HSR Forum on Wednesday 12 March 2025. To book your place at the forum, please book online by Wednesday 26 February 2025.

T