Entry form

Excellence in Work Health and Safety
Sponsored by Galvin Engineering

Entry form instructions - please read before you start.

  • Please familiarise yourself with the questions on this form
  • Prepare all your information before you start using this form
  • Make sure you have a back-up copy of all your information
  • You will need to enter all your information in one session before submitting your entry
  • If you close this form before completing your entry, you will lose all your work and will have to start over

We suggest you prepare your entry in a Word document, then copy-paste from that document into this form.

Section 1 – Member’s name and contact details

Your name:
Mobile:
Email address:
Job title:

Section 2 – Business details

Business name:
Address:
Office phone number:
Office email address:
Website:
Years in business:
Number of full-time employees:
Number of part-time or casual employees:

Section 3 – Referees

Referee #1

Name:
Business name:
Office phone:
Mobile phone:
Email:
Referee #2
Name:
Business name:
Office phone:
Mobile phone:
Email:
Referee #3
Name:
Business name:
Office phone:
Mobile phone:
Email:

Section 4 – Your Submission

In no more than 500 words, please tell us why you think your business is the best in this category.

Criteria: This Award will go to the plumbing business that demonstrates the highest standard in its approach to work health and safety. Judges will want evidence of excellence in health and safety policies, systems, on-the-job practices, solutions and innovation that reduce the risk of work related injury and disease.

Comments: