Fillable NISO Safety Representative of the Year Award 2021

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NISO Safety Representative of the Year Award 2021

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The award
The Safety Representative of the Year winner will be
presented with a Certificate and a € 600 cheque
sponsored by The CPL Institute. The winner will
be announced on Thursday, 4 November .
How to win the award?
There are no hard and fast criteria. The judges will be
interested in details of specific contributions a Safety
Representative has made which resulted in positive
advances in workplace health and safety.
Such contributions might include cases where a Safety
Representative has:
• Identified a situation which might have resulted in injury
or ill health and which has been remedied
• Found a solution to a specific workplace problem, for
example, a manual handling or a transport problem
• Helped to rectify an ergonomic problem, for example,
given advice for the best conditions for VDU/DSE
• Identified health and safety training needs or made a
major contribution to health and safety training
• Raised the level of health and safety awareness in the
organisation
• Organised initiatives to promote employee wellbeing,
health promotion, etc.
National Irish Safety Organisation
IN ASSOCIATION WITH
NISO
Safety Representative
of the Year Award 2021
How to enter
To nominate someone or to enter directly, please
complete the entry form overleaf, which must be signed
by a manager and returned to:
NISO Safety Representative Competition
National Irish Safety Organisation
A11 Calmount Park
Ballymount
Dublin 12
Please download the form from www.niso.ie . Completed
entry forms must be returned to NISO not later than
Friday, 1 October 2021.
The judges
The competition will be judged by a panel of experts in
health and safety, including a representative from NISO
and The CPL Institute.
niso.ie
NISO Safety Representative of the Year Award 201
I wish to nominate:
Job title of nominee:
Name of proposer:
Manager’s Name:
Manager’s title:
Organisation:
Address:
Proposer’s Tel:
Proposer’s Mobile:
Proposer’s Email:
Proposer’s Fax:
Nominee’s Mobile:
Number Employees:
Nature of Business:
Declaration that Safety
Representative is aware
of application.
NISO may store the information you provide on its database / server and fully respects the confidentiality of any
personal data provided. NISO will share the data supplied with The CPL Institute and other members of the
adjudication panel external to NISO to facilitate the adjudication process. NISO will use the data provided for
administering the Award competition and may use the data from time to time to inform you of matters relating to the
Safety Representative of the Year Award. I agree to the terms as to how my personal data will be used. We will be
unable to process your application without you agreeing to the above terms. Please tick the box to indicate that you
understand how we will use your data responsibly.
Entry Form 201
IN ASSOCIATION WITH
IN ASSOCIATION WITH
Normal range of the Safety Representative's activities:
Does the Safety Representative have a good knowledge of the health and safety aspects of the particular organisation? Please
give examples:
Communications: Please give examples of the way the Safety Representative communicates with both management and fellow
employees on health and safety matters:
Outline any improvements or innovations that the Safety Representative has contributed which have resulted in the overall
raising of health and safety standards in the organisation:
IN ASSOCIATION WITH
Entry Form 201
niso.ie
Accidents: Is the Safety Representative involved in accident reporting and investigation? If so, how?
Has the Safety Representative's involvement produced any suggestions for preventative measures? If yes, please list
Has the Safety Representative made any contribution to safety training within the company / organisation?
Have the Safety Representative's suggestions for preventing accidents recurring been constructive?
IN ASSOCIATION WITH
Entry Form 201
niso.ie
Has the Safety Representative made any contribution to health awareness and accident prevention awareness among
employees?
Please add any other information that may be relevant:
Signature of proposer:
Job title of proposer:
Date:
Please feel free to enclose any further documentation that may be relevant to the entry.
Please return this nomination form to:
National Irish Safety Organisation
A11 Calmount Park, Ballymount, Dublin 12.
T: 01 465 9760 F: 01 465 9765 E: awards@niso.ie W: niso.ie
Closing date for applications: 1 October 2021
IN ASSOCIATION WITH
IN ASSOCIATION WITH
Entry Form 201
niso.ie
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Completed 14 September 2021

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