ETFO Health and Safety Activist Award Application

ETFO Health and Safety Activist Award Application 2024-2025
PROCEDURES

The application must be received by ETFO no later than February 1, 2025.
1. Applications are processed by the ETFO Awards Committee. The committee’s recommendations are taken forward to the ETFO provincial Executive for consideration. You can expect to hear regarding the disposition of the award after June 30, 2025.
2. Application forms, in their entirety, will be shared with ETFO staff and members of the ETFO Awards Committee who are ETFO members.
3. Material submitted to the Awards Committee in support of an application become the property of the Awards Committee and will not be returned.
4. ETFO will not accept incomplete applications or applications outside this submission form. Please include as much detail as possible in your responses.
5. If your submission does not adhere to procedures and criteria as notes in this application, if attachments re password-protected or encumber committee consideration, the submissions will be automatically deleted and removed from committee consideration.
6. This form contains mandatory fields that must be addressed to enable the form to be submitted.
7. Preference will be given to those who have not yet received this award.
Please make sure to read the application carefully and in full and fill it out completely.

If you have any questions, please reach out to the ETFO Awards Committee at awards@etfo.org.
CRITERIA

Health and Safety Activist Award

ETFO may grant a Health and Safety Activist Award to an active member of ETFO to recognize their outstanding commitment and involvement in health and safety activities. The recipient shall receive a recognition award and be invited to a luncheon and awards ceremony at the Annual Meeting.

Candidates for the Health and Safety Activist Award must adhere to specific criteria.

Please answer the following mandatory questions:
Applying for more than one award in any given year results in disqualification. Please confirm this is the only application you are submitting to ETFO this year.*

CONFIRM
This award must be nominated by an ETFO Local. Please confirm this fact.*

CONFIRM
Please confirm the local that passed the motion to nominate.*
Please confirm the date the motion to nominate was passed.*

MonthDayYear
Date
Please confirm the nominee is an active member of ETFO in good standing.*

CONFIRM
ETFO Membership #*
OCT/CECE Membership #
Please enter the name of the contact person and or person who made the nomination.

First NameLast Name
Contact Person's Email*
Nominee

First NameLast Name
Address

Street Address

Street Address Line 2

CityProvince

Postal Code
Email
ETFO Local
Years Employed by a School Board
School / Worksite
Work Telephone

Area CodePhone Number
Cell Phone

Area CodePhone Number
Has this member previously been nominated for this ETFO award?

YesNo
Which year?
Please enter the year of the nomination
Has this member received another ETFO award?

YesNo
Which ETFO Award and When
1) Describe, in detail, the health and safety activities with which your nominee has been involved. Indicate if the activity was completed by the nominee or with others.
2) Describe, in detail, the impact of their actions.
3) If the activity(ies) resulted in the creation of a product, please attach it to this application below as a clear photograph or sample of the product. Please note - links/html, google docs and password-protected PDFs will not be accepted.

Browse Files

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4) Describe the training that your nominee has undertaken in the area of health and safety.
5) If health and safety is a part of your nominee’s current position, please describe the role and responsibility.
6) Federation involvement (local, regional, provincial and/or national levels – include years).
7) Professional involvement (curriculum writing teams, workshop presentations, leadership activities).
8) Please upload any attachments here. Please note - links/html, google docs and password-protected PDFs will not be accepted.

Browse Files to Upload

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CONFIDENTIAL PERSONAL INFORMATION

Self-identification allows ETFO to achieve a critical goal, supporting and encouraging the participation of all individuals in ETFO programs, services and events. By completing this section, ETFO will be able to undertake the necessary statistical analysis to achieve this goal. All information collected and the reporting of statistical data will ensure full confidentiality of all. Although the completion of this section is voluntary, ETFO encourages you to self-identify.
Self-Identification

First NationsMétisInuitperson with a disabilitytwo-spirit, lesbian, gay, bisexual, transgender, queer, questioning, +racializedwoman
If nominee identifies as racialized, please specify (e.g.Black, East Asian, Mixed Race)
What term describes the nominee's gender?
Please indicate the nominee's pronouns
This application requires the sign off of the ETFO Local President and Secretary. After the submission of this application, emails will be automatically sent to them with a copy of the application, and indicating the following:

Your sign off is requested regarding the application for this award.

Please review and forward this application to the ETFO Awards Committee at awards@etfo.org, indicating that you sign off on this application.

Your sign off is required for the completion of this application.

Please make sure to fill out the following information accurately so that it is sent to the correct person.
Name of Local ETFO Secretary*
Local Secretary's Email*
Name of Local ETFO President*
Local ETFO President's Email*
STATEMENT BY NOMINEE(S)/REPRESENTATIVE OF NOMINATED GROUP - I have read the criteria and procedures of this award and if chosen as the successful candidate, agree to abide by them. To the best of my knowledge, all information on this application form is correct. By signing this document, I consent to my name being published in ETFO publications and being included in ETFO media releases. I further consent that my contact information may be provided to local media upon request and for no other purpose.
Applicant's Signature

Clear
Date

MonthDayYear
Date
Should be Empty:

ETFO Health and Safety Activist Award Application 2024-2025

PROCEDURES

CRITERIA