2017 ACSA Annual Achievement Awards
Pacesetter Award Nomination Form
Description
The Pacesetter Award recognizes the innovations and achievements in safety of individuals
from the Alberta construction industry, along with their outstanding service to the Regional
Safety Committee (RSC) in their community.
The Award is presented to an individual from each of the following eight regions in Alberta:
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Calgary
Edmonton
Grande Prairie
Lakeland
Lethbridge
Medicine Hat
Parkland
Wood Buffalo
Eligibility
This category is open to individuals who:
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have completed at least one classroom course and/or CSTS with the ACSA; and
represent on one or more of the eight RSCs in Alberta.
Conditions
Note the following important conditions of nomination:
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Each question must be addressed in the nomination
Nominees are strongly advised to include supporting material/evidence with their
submission. For example, photos, testimonials, data, reports etc
Self-nominations are not permitted
Winners from the previous year’s event are not eligible to be nominated
Nominations close on Friday December 16, 2016 at 4:00pm.
Should you need assistance with your nomination, please contact [email protected] or
call us at 1.800.661.ACSA (2272).
1. Nominated person
Name:
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Position:
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Company:
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RSC:
Choose a region.
2. List the courses/training this individual has completed with the ACSA?
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3. Contact details of person to liaise with regarding this nomination.
Name:
Position:
Company:
Region:
Email:
Phone:
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Choose a region.
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4. Describe your relationship with this individual.
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5. How long has this individual been working in the construction industry?
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6. How has this individual demonstrated safety leadership?
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7. What innovation/project has this individual initiated or participated in to improve the
overall safety environment? What did they achieve? Please give examples and figures
if possible.
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8. Give a brief history of the individual’s involvement with the local RSC, providing one
example of a valuable contribution they’ve made.
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Submission
Thank you for completing this nomination for the Pacesetter Award.
Please attach any additional information or supporting material to this nomination form and
email it all together to [email protected]. Nominations sent by post will not be accepted.
You will be notified of your result in writing in January 2017. Best of luck!
Permission
In the interest of sharing corporate knowledge, I give permission for the key points of my
nomination to be shared publically should I win.
Yes: ☐
No: ☐