Safety Award For Excellence
Nomination Form

Environment, Health & Safety would like to recognize those who have excelled
in creating and maintaining a safe and healthy workplace consistent with EH&S policies.

NOMlNATE AN INDIVIDUAL

Nominee's name:

Nominee's department:

    Location:

NOMINATE A WORK GROUP

Name of the work group:

List the names of each member of the group, separated with commas:

Work group's department:

Describe why this individual or work group deserves this award.

Nominees must have shown initiative by satisfying at least 1 of the 5 criteria listed below. Include examples and specifics – convince the judges!

1. Good in-house safety program: For broad implementation of safety throughout the workplace
2. Active role in safety: For being a strong advocate of health and safety
3. Improvement: For demonstrating significant improvement over previous conditions
4. Consistency: For maintaining a good safety program over a number of years
5. Product or process development and implementation: For special effort given to a specific aspect of safety in the workplace

List any references or contacts that may be useful if the evaluators need additional information.

Your name:

Your department:

Your telephone:

Your e-mail (required):

Review the information entered above. If correct, click on the "Send" button below and your request will be sent as e-mail to EH&S. Thanks very much for participating!

Return to the Safety Award For Excellence page

Environment, Health & Safety
University of California, San Diego

Last modified 2/1/2008