Canadian Registration
Board of Occupational
Hygienists

Lifetime Achievement Award – Nomination Form

Nomination Submission Deadline:          May 1

Purpose of Award

The Andrea Sass-Kortsak Lifetime Achievement Award is presented to an individual in recognition of extraordinary lifetime achievement in the field of occupational hygiene.

Before submitting your application, please use this checklist to ensure you have or will comply with all requirements, endorsement forms can be submitted by someone other than the nominator, like the nominee or someone else, at a later date as long as it is before the deadline.

☐ Nomination Form.

☐ Two Endorsement Forms.

☐ Nomination is submitted by the deadline – May 1.

Lifetime Achievement Award - Nomination

Nominee Information

Name
Name
First
Last
Nominee Information
1. Briefly describe the nominee’s significant and exemplary contributions to the field of Occupational Hygiene that have transpired over a lifetime of work locally, nationally or internationally.

2. Describe the nominee’s work related achievements.

  • Excellence and recognition of achievements within the profession, business or industry, or the education sector that has set a benchmark for occupational hygienists to strive for. (Attach relevant documentation such as awards, letters of recognitions etc)
  • Proven positive impact demonstrated through projects or initiatives to improve worker health and safety. (e.g. list examples of projects and initiatives, preference given to projects and initiatives in Canada)

3. Describe the nominee’s service to the profession.

  • Active participation in occupational hygiene associations, societies, institutes, etc. (Attach proof of membership of an organization, chair of a committee, Board of Directors)
  • Record of mentoring students and/or junior occupational hygienists and/ or safety professionals.
  • Writing, speaking, teaching and delivering significant contributions to the field, body of knowledge and/or understanding of OH. (Attach proof of publications, articles, speaker roster at conferences)
  • Challenged our way of thinking, innovation in, and/or enhanced understanding of the field of OH

4. Describe the nominee’s service to the community.

  • Active participation in voluntary organizations, community organizations, and other paid and/or unpaid work beyond the profession.

Nominator Information

Name
Name
First
Last
Address
Address
City
State/Province
Zip/Postal

Maximum file size: 516MB

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