Zero Fatalities Safety Summit Award Nomination Form
AWARD PROGRAM INFORMATION
The Zero Fatalities Award Program recognizes individuals and organizations who have made contributions to transportation safety in the State of Utah. The program is sponsored by the Utah Department of Transportation (UDOT), the Utah Department of Public Safety (UDPS), and many other traffic safety partners that are dedicated to reducing death and injury on Utah's roadways. The program recognizes accomplishments in the public and private sector by individuals and entities that promote safety, including state and local governments, federal agencies, businesses and organizations. DEADLINE FOR AWARD SUBMISSION IS MARCH 1st.

Nominations should include:

1. Description of the program(s) and/or activities that the nominee has conducted, why they occurred and what made them unique.

2. Supporting information and/or data regarding what issues existed and what the desired outcomes were.

3. Description of outstanding elements or accomplishments of the nominee or programs (e.g. number of people trained, number of people impacted, etc.).


ELIGIBILITY
Any individual, organization, business or government agency is eligible. The nominee must have made an outstanding effort to change the attitudes and behaviors of motorists leading to the reduction of crashes, injuries and fatalities associated with transportation in Utah.


CRITERIA FOR SELECTION
There are eight award categories for which nominations will be accepted. Award selection will be made by the Zero Fatalities Safety Summit Planning Committee. Entries will be judged for impact on the community, program effectiveness, creativity, innovation and overall dedication to the field of transportation safety. An additional award category, Outstanding Traffic Safety Program Award, recognizes one UDPS and one UDOT project or subgrantee, and is selected by Department leadership.

AWARD CATEGORIES
To review award categories, please visit ut.zerofatalities.com/summit/awards-program/

NOTIFICATION & PRESENTATION OF AWARD
Winners will be notified by March 6, 2020 and will be honored at the Zero Fatalities Safety Summit Awards Ceremony on Wednesday, April 1, 2020 at the Davis Conference Center in Layton, Utah. Award recipients will be able to attend the Summit at no charge and will be provided with lodging and other travel expenses, if necessary. In addition, recipients will be able to bring up to four additional guests to the awards luncheon.


SUBMIT
Completing this form online will submit your nomination. If you have any questions or concerns please contact Kristen Hoschouer at 801-554-5049 or khoschouer@utah.gov. DEADLINE FOR AWARD SUBMISSION IS MARCH 1st.


NOTE
Activities and programs must have taken place during calendar years 2018-2019. This requirement applies to all award categories except the Zero Fatalities Leadership Award, which honors an individual for sustained outstanding leadership. For nominations in this category, please include all relevant information that demonstrates a long-term effort to make Utah's roadways safer.
Select Award Category
Nominee Information
Please answer the following questions about the nominee.
First and Last Name
Your answer
Title
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Employer (if applicable)
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Street Address
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City
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State
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Zip Code
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Phone Number
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Email Address
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Nominator Information
Please answer the following questions about the person making the nomination.
First and Last Name
Your answer
Title
Your answer
Employer (if applicable)
Your answer
Street Address
Your answer
City
Your answer
State
Your answer
Zip Code
Your answer
Phone Number
Your answer
Email Address
Your answer
Please explain why you are nominating this individual or group for a Zero Fatalities Award. Review the award categories (ut.zerofatalities.com/summit/awards-program/) and provide information that is relevant to the award for which you are nominating this person, team or organization.
Your answer
Please include a description of the programs and/or activities that the nominee has conducted. Why did it occur and what made it unique? Include any relevant information and data on what problems existed and what the desired accomplishments were.
Your answer
Please describe any outstanding elements or accomplishments of the nominee or program (e.g. number of people trained, number of people impacted, reduction in fatalities etc.)
Your answer
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