*Nominee Name
*Current Company
*Position Title
*Years of Service
*If they have worked at their current company for less than five years, please include their title, previous employer(s), and years of service.
*Email Address
Phone Number
Provide a link to their LinkedIn profile.
*Workers' Compensation Experience Modification Rating for the past five years.
*OSHA Total Recordable Incident Rate for the past five years.
*OSHA Days Away Restricted/Transfer (DART) Rate for the past five years.
If the nominee oversees the Fleet Safety Program, please include the number of vehicles, miles driven, and number of vehicle accidents for each of the past five years.
If the nominee oversees Commercial Motor Vehicles, please include the DOT BASICS Out-of-Service percentages.
Please provide any membership in professional organizations and offices held.
Describe the nominee's volunteer experience.
Please list any publications or speaking engagements the nominee has had.
Please provide the nominee's career EHS accomplishments.
*Please describe the elements of the current safety program that the nominee oversees.
*Please describe why the nominee deserves to be recognized as the 2025 Safety Woman of the Year, including examples of work completed.
Please include letters or statements of recommendation for the nominee.
*Nominator's Name
*Nominator's Email Address