Star Awards Nomination Form 2014 Protected

TRANSPOWER SAFETY
THANKS AND RECOGNITION
(STAR) AWARDS
NOMINATION FORM

Please complete all fields including contact details

To avoid duplicate nominations please ensure that all relevant parties are informed about your nomination.

I WOULD LIKE TO NOMINATE:[PLEASE CHECK ONE]

a team an individual

PLEASE TELL US ABOUT THE PERSON/TEAM YOU’RE NOMINATING:

Name: R
Role/title:
Company name: (e.g. Transpower Grid Projects, contractor name, etc.)
Location/office:
Address:
Email: Phone number:

I WOULD LIKE TO NOMINATE THIS TEAM/INDIVIDUAL IN THE FOLLOWING CATEGORY:

One category only for each nomination

[PLEASE CHECK ONE]

Top ProjectBest Safety by Design for Projects or Maintenance

Best Safety and Health Performance - TeamApprentice of the Year

Best Safety and Health Leadership - IndividualBest Safety Innovation

Top Depot or Office

What health or safety issue did this team/individual address?
How did they address the issue or problem? What actions did they take?
What was the outcome of this initiative?(e.g. improvements to our safety performance, injury-free project, etc.)
Would you like to add any further comments about how this team/individual has contributed to an injury free workplace?

PLEASE TELL US ABOUT YOURSELF:

The person nominating cannot be the same person as the nominee

Your name:
Your role and division/organisation:
Your address/location:
Your phone number:
Email:

Please feel free to provide additional information supporting your application including photos.

THANK YOU. You have now completed your part of the nomination form.
Please identify the nominee’s line manager and forward this nomination to them to complete the information below.

NOMINEE’S MANAGER:

Manager’s name:
Manager’s title and division/organisation:
Manager’s phone number:
Please add your comments to this nomination for your staff member or team.
Either add below or attach as necessary.

Please feel free to inform your team or staff member about their nomination. You may wish to share a copy of this nomination form with them or recognise their nomination at your next team meeting.

Email this completed nomination form to .
Please provide the nomination form and supporting documents as one PDF if possible.
Alternatively you can send it to:
Safety and Health Coordinator
Transpower
Level 5 Transpower House
96 The Terrace
PO Box 1021
Wellington
Any calls or requests for additional information should go to 0800 SAFET1 or 0800 723 381

ALL NOMINATIONS MUST BE RECEIVED BY 5PM ON 6 JUNE 2014

All nominees will receive a letter acknowledging their nomination.
Finalists may be visited by the judging panel and will be invited to attend the STAR Awards dinner on 28 August 2014.