SECTION 1: NOMINATOR'S DETAILS Nominator's name: Nominator's job title: Nominator's department: Nominator's email: Nominator's telephone number: Which region / business line are you primarily based in? Select region or business line UK & Africa RBL Europe (Stork and EQIN) Equipment & Energy Solutions (Power Services) North America Trinidad & Tobago Colombia Peru Middle East Australia & New Zealand SECTION 2: NOMINEE'S DETAILS Nominee's name: Nominee's job title: Nominee's department: Which region / business line is the nominee primarily based in? Select region or business line UK & Africa RBL Europe (Stork and EQIN) Equipment & Energy Solutions (Power Services) North America Trinidad & Tobago Colombia Peru Middle East Australia & New Zealand SECTION 3: AWARD CATEGORY Please indicate which award you are nominating your colleague for: AWARD FOR HSE IMPROVEMENT For an individual or team who has developed and introduced a new technology, system or work practice, which has improved Stork, Client or community HSE. Nomination criteria: Give details of the improvement, Evidence of tangible benefits the improvement has achieved for Stork, Client(s) or the community, Please provide any supporting material (e.g. testimonials, documents, photographs). AWARD FOR INCIDENT PREVENTION For a proactive individual who identified hazards at planning or execution stage and took action, beyond existing risk controls, to prevent harm. Nomination criteria: Details of the identified hazard and preventive action(s) taken or put in place. Summarise the possible harm if the preventive action had not occurred. Describe how the hazard and preventive action been communicated to prevent recurrence. AWARD FOR BEST TEAM For a team who has achieved excellent Health, Safety or Environment results, demonstrated a culture of care for those within the team and proactively contributes to a positive safety culture within Stork. Nomination criteria: Summarise why the team is being nominated Examples of positive and proactive work carried out to improve Stork’s safety culture. Evidence of meeting or exceeding key Stork and/or Client expectations. AWARD FOR HSE HERO An inspirational individual who is admired for their personal HSE leadership, demonstrating responsible HSE behaviours, committed to encouraging similar behaviours from colleagues and is a great exemplar of our SAFETY core value. Nomination criteria: Explain why this individual inspires you Benefits that the individual's approach has brought to his/her team, work site or community Provide any supporting materials (e.g. commendations, photographs, examples of individual's work). SECTION 4: MAKE A CASE Please explain why you are making this nomination. Try to cover all or some of the nomination criteria for the relevant category. Use an additional sheet if required. SECTION 5: OPTIONAL ATTACHMENTS You can attach up to three word documents, images or PDF's to further explain your nomination: The form you tried to submit contains one or more errors. Please correct and try again.