2020 UMA Safety Leader of the Year Award Nomination Form
UMA’s Safety Leader of the Year Award Honors a person or organization with a demonstrated commitment to the industry; who has contributed in a significant way to the safety performance of the industry and/or his/her company; and who has been an active participant in industry initiatives/organizations and community/civic affairs.

The deadline for nominations is September 27, 2019. If you have questions regarding the process, please contact Matthew Daecher at (717) 975-9190 or matt@safetyteam.com.

Email address *
Your Name
Your answer
Your Company
Your answer
Your Phone
Your answer
Nominee Name and Company
Your answer
Compose your narrative about the nominee
In your own narrative, please describe why you are nominating this person or organization, including the following points in the narrative:
• Nominee’s industry experience/history
• Safety achievements (how has nominee impacted safety at their organization or the industry?
• Nominee’s industry service
• Non-industry activities of nominee
• Other qualities & considerations of nominee
Your answer
Extra space if needed
Your answer
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service