Nature of Business (required)
Size of Business (required)
Title of Nominee's Department (required)
Number of Employees in Department (required)
Nature of Relationship to Nominee (i.e., "Immediate Supervisor") (required)
Please attach a current description of the nominee's position from the employer/organization, plus an organization chart depicting the safety function of the nominee's position.
On no more than two (2) pages of your organization's letterhead, please concisely and specifically describe the scope and quality of the nominee's job-related duties and achievements, plus any other safety-related activities of which you have personal knowledge.