Canadian Registration
Board of Occupational
Hygienists

Lifetime Achievement Award – Endorsement 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.

Note:

This form is for the endorsement of an already-nominated candidate for the Lifetime Achievement Award.

Before submitting your application, please use this checklist to ensure you have complied with all requirements.

☐ Nomination Form.

☐ Two Endorsement Forms.

☐ Nomination is submitted by the deadline – May 1.

Lifetime Achievement Award - Endorsement

1. Nominee’s Information

The person you are endorsing
Name
Name
First
Last

2. Written Justification

Briefly describe the Nominee’s exemplary contributions in the practice of Occupational Hygiene that have culminated over a lifetime of work, contributing to a legacy of service to the profession.

3. Endorser Information

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

Maximum file size: 516MB

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