Welcome to the Women in Safety and Health Award Nomination Form

This distinguished award recognizes outstanding women in safety and health who have demonstrated exceptional leadership, innovation, and dedication in the field.

The award recipient will be honored at the end-of-year Women in Safety Event in December and celebrated during the Utah Safety Council’s Annual Meeting and Awards event.

Don't forget to submit supporting documents with your nomination!

Thank you for recognizing the remarkable achievements of women in safety and health!

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* 1. Year

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* 2. Nominator's Information

Name

Title

Company Name

Email address

Phone number

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* 3. Nominee's Information

Name

Title

Company Name

Email address

Phone number

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* 4. How has the nominee contributed to the Utah Safety Council’s objective of making Utah a safer place to live and work? (100 words or less)

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* 5. Provide specific examples of how the nominee has demonstrated creative excellence related to safety initiatives. Please include details on the strategies used, the impact of these initiatives as a result. (100 words or less)

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* 6. Provide specific examples of the nominee's involvement in implementing safety cultural changes within their workplace or industry. Include details on the strategies used, the impact of these changes, and any measurable improvements in safety as a result. (100 words or less)

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* 7. Describe how the nominee has shown exceptional performance as a safety & health role model. Include instances of their impact, such as guiding teams, implementing safety protocols, fostering a safety culture, or inspiring others to prioritize safety. (100 words or less)

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* 8. Explain how the nominee enhances safety and health standards in their workplace or industry. Provide examples of measures they have implemented or supported to improve safety practices, mitigate risks, and promote well-being among colleagues or industry peers. (100 words or less)

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* 9. The nominator must provide supporting materials related to the nominee's accomplishments. These may include photographs, articles, certificates, handbooks, posters, and other relevant documents.

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.