Health & Safety Champion Nomination Form
Nominee Information
| Nominee's Name: | [Name] | 
| Job Title: | [Position] | 
| Department: | [Operations] | 
| Email: | [Email Address] | 
| Contact Number: | [Contact Information] | 
Nominator Information
| Nominee's Name: | [Name] | 
| Job Title: | [Position] | 
| Department: | [Human Resources] | 
| Email: | [Email Address] | 
| Contact Number: | [Contact Information] | 
Nomination Details
| Category | Details | 
| Safety Awareness Campaign | [Name of Nominee] spearheaded a safety awareness campaign, including informative sessions and workshops for employees. | 
| Emergency Response Drill | [Name of Nominee] organized and conducted regular emergency response drills, ensuring all staff were well-trained and prepared. | 
| Hazard Identification Program | [Name of Nominee] implemented a hazard identification program that resulted in identification and mitigation of potential risks. | 
| Safety Committee Leadership | [Name of Nominee] led the Safety Committee, fostering a culture of safety by encouraging open communication and collaboration. | 
| Safety Policy Review | [Name of Nominee] actively participated in the review and improvement of safety policies, ensuring they aligned with industry standards. | 
| Cross-Department Safety Training | [Name of Nominee] collaborated with various departments to conduct cross-department safety training sessions, promoting a unified safety approach. | 
Additional Comments
Provide any additional comments or information that supports the nomination:
[Name of Nominee]'s dedication to safety is evident in his consistent efforts to create a secure workplace. His proactive approach and leadership have significantly contributed to our organization's safety culture.
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