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2016 Vice Chancellor’s Awards for Health and Safety Excellence NOMINATION FORM FOR INDIVIDUALS & TEAMSThe Vice-Chancellor’s Awards for Health and Safety Excellence was introduced in 2015 to encourage and reward outstanding health and safety performance by an individual or a team. To be eligible for nomination, nominees must be members of the University of Newcastle academic or professional staff who are either ongoing or on a fixed term appointment normally greater than 12 months.

A team may consist of either a work unit team or individuals from different work units whose collaboration has produced an outstanding contribution.

The majority of a group must consist of an academic or professional staff member who can demonstrate their lead in the activity/project. The team members must be identified and their critical contributions and role clearly stated.

The Award recognises performance that exceeds what would be expected of staff in the normalperformance of duties.

Award recipients receive $2,000 for individual nominations and $4,000 for group nominations, to be paid either as salary or Professional Development. Awards will be presented at a public Awards Ceremony scheduled for Monday 5 December 2016 at the Conservatorium.

Completed nomination forms should be submitted via email in one PDF file to professional-staff-awards@newcastle.edu.au.

If you have any queries please contact Brigitte Hudson on (02) 4921 5599 or Brigitte.hudson@ewcastle.edu.au

NOMINATIONS WILL CLOSE AT 5PM ON FRIDAY 14 October, 2016.Please note late, incomplete or nominations with nominator statements in excess of the stated word limits, will not be considered by the Selection Committee.CRITERIANominations for individual and team awards must meet essential criteria #1. Team nominations should also be able to demonstrate compliance with at least two of the #2 criteria from the list:

- #1 An outstanding and exceptional initiative which has contributed to a safer and healthierworkplace;

- #2 H&S committee meetings are held on schedule and actions arising are closed in timeframes;- #2 Safety inspections are conducted on schedule and corrective actions arising are closed on time;- #2 Hazard Registers for the team area are available and up to date;- #2 Standard Operating Procedures for the team tasks are available and up to date;- #2 Chemwatch inventory completed and up to date

VALID NOMINATIONSFor nominations to be valid they must:

- Be made on the forms provided.- Include the name of each Nominee, list of Nominators and two signed supporting statements

by the nominators must be included. Attachments will not be considered.- Include the signature of the nominee’s/nominees’ supervisor or equivalent.- Include endorsement from the nominee(s) Head of School / Director or equivalent, via a short

statement of no more than 100 words. Team/group nominations involving more than one unit/area must have the endorsement of the Head of each School/Unit via a short statement of no more than 100 words

- Conform to the rules set out in the procedure document Vice-Chancellor’s Award for Health and Safety Excellence, with particular attention to Clauses 3.1 (Eligibility) and3.2 (Nominations).

Section 1 – Individual Nominations

Name of nominee:

Position/HEW level:

School/Unit:

Faculty/Division:

Mail location/Ext. number:

Supervisor’s name:

Endorsement by HoS / Director or equivalent (short statement of no more than 100 words):

HOS/Director signature:

Nominee notified: Yes

1st Nominator’s name:

Relationship to nominee:

Position: Extension No:

2nd Nominator’s name:

Relationship to nominee:

Position: Extension No:

Section 2 –Team Nominations

Name of Team:

Names of Team Members & HEW levels:

School/Unit:

Faculty/Division:

Mail location & Ext. No. of Team Leader:Supervisor’s name:Endorsement by HoS / Director or equivalent (short statement of no more than 100 words):

HOS/Director signatures (required for each School/Unit):

Nominee notified: Yes

1st Nominator’s name:

Relationship to nominee:

Position: Extension No:

2nd Nominator’s name:

Relationship to nominee:

Position: Extension No:

Section 3 - Supporting Statements from Nominators

Nominator 1: Please provide the following in support of this nomination:(For teams, the team members must be identified and their critical contributions and role clearly stated.)

1. A BRIEF SUMMARY OF THE ACHIEVEMENT THAT CAN BE USED AS PART OF THE AWARDS CITATION IF THE NOMINATION IS SUCCESSFUL (max 100 words):

2. NOMINEE’S ACHIEVEMENTS AND HOW THIS MEETS THE NOMINATION CRITERIA (max 250 words):

3. HOW THE ACHIEVEMENTS ALIGN TO NEW DIRECTIONS STRATEGIC PLAN (max 100 words):

4. HOW THE ACHIEVEMENTS DEMONSTRATE THE BEHAVIOURS WITHIN THE LEADERSHIP FRAMEWORK (max 100 words):

Name (please print):

Signature: Date:

Nominator 2: Please provide the following in support of this nomination:

1. NOMINEE’S ACHIEVEMENTS AND HOW THIS MEETS THE NOMINATION CRITERIA (max 250 words):

2. HOW THE ACHIEVEMENTS DEMONSTRATE THE BEHAVIOURS WITHIN THE LEADERSHIP FRAMEWORK (max 100 words):

Name (please print):

Signature: Date: