Safety Award Nomination Form

3 Awards 1000 x 531

Safety Award Nomination Form

Please support your nomination by sharing an example of how the nominee demonstrated professionalism, dedication, commitment, courage, passion and leadership in the elimination of human error.

Examples of your support:
- Share a time when the nominee stayed professional in a challenging situation.
- How the nominee inspired you to be a safer aviator.
- How nominee commitment to safety saved lives or prevented an accident.

Nominee Information

First Name

Last Name

Company

Title

E-Mail

Phone

How do you know the nominee?

How long have you known the nominee?

Has the nominee ever attended a Safety Standdown Seminar?
 Yes No
If so, when?

Your Information

First Name

Last Name

Company

Title

E-Mail

Phone

Have you ever attended a Safety Standdown Seminar?
 Yes No
If so, when?

How did you hear about the award?

Safety Award Criteria

The following criteria must be met in order to submit your nomination for this award. You must support your answers with specific examples of how this nominee has displayed required characteristics in the provided field. Incomplete entries will be rejected.

My Nominee for the Safety Award:

 Has gone above and beyond the minimal job expectations.
 Lives by the framing principles of Safety Standdown.
 Has demonstrated an exceptional dedication, commitment, and contribution to aviation safety through their actions and behavior.

Possesses the following personal traits:

 Professionalism
 Dedication
 Commitment
 Courage
 Passion
 Leadership

Actively displays the following behaviors:

 Makes a difference
 Encourages others through their personal example
 Sets the highest standards
 Makes a conscious decision to do the right thing
 Believes that good is never good enough
 Mentors others in their pursuit of excellence and professionalism in aviation

Adheres to the Safety Standdown Framing Principles (HEPAC):

 Human Factors are responsible for 80% of aviation error. The risk can be eliminated by continuous knowledge-based training tailored to the individual and organization needs.

 Strong Ethics are foundations for judgment in a demanding environment.

 True Professionals will have the discipline to seek the highest standard above and beyond what the regulations require.

 Automation technology relies on proficient operation. Must eliminate the gap of inefficient procedures and systems between technology and humans who operate it.

 Safety Culture starts at individual empowered accountability.

Summary of Eligibility

Please provide specific examples of the above safety traits. These examples must show how the nominee went above and beyond and should not be just examples of how the nominee excels at their job. Examples could include volunteer opportunities, committees, local/regional/national seminary presentations, or anything else that shows the nominee commitment to advancing safety. Additional documents could include letters of recommendation from peers/leaders who know the nominee.

Please upload any relevant documents, awards, photos or files to support your nomination.