2017 ACSA Annual Achievement Awards
HSA of the Year Award Nomination Form
Description
The Health & Safety Administrator (HSA) of the Year Award recognizes a safety professional who has worked hard towards building their career in safety through the management of projects and initiatives in their work, as well as through extracurricular activities such as training and volunteering.
By shining the spotlight on these safety leaders, we share their efforts with the industry in making Alberta’s construction industry the safest anywhere.
Eligibility
This category is open to individuals who:
- have completed and received their HSA designation with the ACSA.
Conditions
Note the following important conditions of nomination:
- Each criteria must be addressed in the nomination.
- Nominees are strongly advised to include supporting material/evidence with their submission.
- Self-nominations are not permitted.
- Be available for a follow up call in January.
Nominations close on Friday December 16, 2016 at 4:00pm
Should you need assistance with your nomination, please contact or call us at 1.800.661.ACSA (2272).
Your contact information
Name: Click or tap here to enter text.
Phone: Click or tap here to enter text.
Email: Click or tap here to enter text.
Nominated person information
Name: Click or tap here to enter text.
Position: Click or tap here to enter text.
Company: Click or tap here to enter text.
Phone: Click or tap here to enter text.
Email: Click or tap here to enter text.
How long have they been a HSA? Click or tap here to enter text.
- Briefly describe his/her approach to health and safety administration:
- Give an example of his/her dedication to health and safety:
Click or tap here to enter text.
- How does he/she earn the respect of their coworkers when enforcing safety at work?
Click or tap here to enter text.
- List any extracurricular activities he/she have undertaken to further their safety career:
Click or tap here to enter text.
- Give an example of a project or initiative they were involved in that improved safety in the workplace or community. Please give examples and figures if possible:
Click or tap here to enter text.
Submission
Thank you for completing this nomination for the HSA of the Year Award.
Please attach any additional information or supporting material to this nomination form and email it all together to . Nomination sent by post will not be accepted.
You will be notified of your result in writing in January 2017. Best of luck!
Permission
In the interest of sharing corporate knowledge, I give permission for the key points of my nomination to be shared publically should I win.
Yes: ☐
No: ☐