Health & Safety Committee Member Nomination Form
NOMINEE
Name | |
Department | | Title | |
Email | | Number | |
NOMINATOR
Name | |
Department | | Title | |
Email | | Number | |
REASON FOR NOMINATION
Please describe why you are nominating this individual for the Health & Safety Committee, highlighting their qualifications, experiences, or traits that make them a suitable candidate (max 300 words). |
NOMINEE’S EXPERIENCE IN HEALTH & SAFETY
Detail any relevant experience, training, or certifications the nominee has in health and safety. |
CONTRIBUTIONS TO WORKPLACE SAFETY
Describe any specific contributions the nominee has made to improve workplace safety within the organization. |
ENDORSEMENT
NOMINEE CONSENT
Has the nominee consented to this nomination?
Nominee’s Signature:___________________
NOMINATOR DECLARATION
I hereby declare that the information provided in this form is accurate and complete, to the best of my knowledge.
Nominator’s Signature:_______________________
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