Water Safety Recognition Certificate

Nomination Form

Nomination details:

·  WSAC Member nominator
Nominee Organisation’s Name
Nominee’s Name / Title / Given Name / Last Name
Position
Telephone (BH) / Mobile
E-mail
Postal Address / Street Address or
PO Box Number
Suburb / Postcode

Summary of reasons for the nomination:

·  Signature
Date

Nominations for the NSW Government Water Safety Recognition Certificate are designed to acknowledge the work of the community in water safety over the long term, where individuals or organisations may not be eligible for annual or other awards.

Nominees should satisfy the following criteria:

·  The organisation and/or program nominated must have substantially contributed to water safety in their community within NSW for more than the past 12 months.

·  An organisation or program cannot be the recipient of a Recognition Certificate more than once.

Guidelines for nomination:

1.  The nomination form must include a short summary, detailing the reasons for the nomination.

2.  Nomination forms are available on the NSW Government’s water safety website at www.watersafety.nsw.gov.au

3.  Nominations can be submitted by anyone at any time of year however they must be submitted via a member of the Water Safety Advisory Council (WSAC).

4.  Nominations should be no more than one page in length.

5.  Nominations will be submitted to WSAC members for consideration and to provide advice to the Minister for Police and Emergency Services.

6.  Recognition certificates will be presented by the Minister for Police and Emergency Services or his representative to successful nominee/s.

7.  There will not be a set limit to the number of Certificates that can be issued in a 12 month period.

Return of nomination forms:

Once completed the form may be emailed to

or posted to:

Water Safety Advisory Council Secretariat

Ministry for Police and Emergency Services

Level 13, 4-6 Bligh Street

Sydney NSW 2000