Nomination form – Sabita CEO Merit Award for notable HSE
achievement 2014
Nominate an employee:
Nominee name:
Job title:
Company:
Company phone number:
Nominate a Group:
Name of group:
List the names of each member of the group separated with commas:
Accomplishments
Describe why (not more than 150 words) this individual or group deserves this award. Include
examples and specifics. Convince the judges!
Nominated by:
Job title:
Company:
Company phone number:
E-Mail (Required):
1. Endorsement by CEO of participating Member Company
I submit that the information provided in this application is accurate and hereby fully endorse this
application to be considered for recognition in terms of the SABITA HSE Awards Scheme.
Date: ……………………..
CEO Signature: ………………………………………

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