Workplace Health and Safety Excellence Awards Nomination Form
The ASMC Board of Directors has established a People & Safety Committee. A purpose of the Committee is
to facilitate continuous improvement in Work Health & Safety. The People & Safety Committee champion the
guiding principles and values that inform and underpin the action taken to drive continuous improvement in
health and safety performance. Through harnessing the expertise and leadership of its members, the ASMC
strives to develop, inform and share best practice health and safety management across all sugar milling
companies.
The Workplace Health and Safety Excellence Awards aim to do this through visible leadership and participation
in good safety practice and risk management.
Awards are open to all employees of Sugar Mills and
nominations should be submitted through your Line Manager and company Safety Manager, nominations
close 5 February 2016. Any further questions contact garry.whiting@asmc.com.au.
Award Nomination Category - Please choose one of the categories below:

Best Solution to a Specific Workplace Health and Safety Issue

Health and Safety Champion of the Year

Excellence in stay at work.
Nominee(s)
Name
Position
Location
Name
Position
Location
Name
Position
Location
(add lines as appropriate)
Date
Nominated by
(add lines as appropriate)
Leader
Endorsement
Initiative Title
Description of
WH&S Initiative
(what was the issue being
solved)
This section must be
completed
WH&S Outcomes
& Benefits
(Describe specific, tangible
outcomes and benefits to
HSE obtained. Attached
additional information as
required)
This section must be
completed
Additional
Information
Note: All areas of this form shall be completed before submitting for consideration. After completing, submit this
nomination form to your WH&S Manager for endorsement.
WH&S Manager
Endorsement
Name
Location
Date
Best Solution to a Specific Workplace Health and Safety Issue
In this award the ASMC would like to recognise an individual or a team which has found an innovative and
valuable business solution to a workplace risk or hazard. The solution may or may not be as a result of
capital expenditure to solve the problem given that innovation can be a new work practice.
Transferability of entry
Can this initiative be applied across other industries and workplaces?
Innovation
To what extent is this initiative innovative, creative, new and different?
Risk Control
How does the initiative apply the hierarchy of control?
 (Elimination, substitution, engineering, isolation, administrative controls)
Risk Profile
What difference would the initiative make to the risk profile of a workplace as a whole?
Commitment
What commitment is evident in the initiative? Details of resources invested in developing the solution (human and financial) and in
ensuring it was successfully integrated into the business.
Consultation
Was consultation built into the development/implementation/on-going monitoring of the initiative?
Evaluation
How effective is the initiative? Evidence of injury and risk reduction.
Health and Safety Champion of the Year
In granting this award the ASMC would like to recognise a manager or an employee who has as part or all of
their role a responsibility to champion Health & Safety and work to improve safety performance within the
workplace. The intention is to recognise and reward Health and Safety Representatives for how they engage
managers and employees in identifying and managing risks to mill employees, suppliers and the general
community.
Commitment
To what extent does the HSR demonstrate commitment to workplace health and safety and representation?
Representation
To what extent does the HSR foster representation and communication in the workplace?
Functions
To what extent does the HSR fulfil their powers and function under the Act?
Achievements
Are the achievements outstanding considering the barriers faced?
Excellence in stay at work
The ASMC would like to recognise the important and specialist skill it takes to effectively coordinate the
return to work of a worker who has been injured. Getting affected workers productively back into the work
place as soon as is practical is a key part of helping the individual feel productive and make a full recovery.
This function may only be a small part of the persons overall responsibilities, however we think it is essential
and should be recognised. This award may also be used to recognise an individual who has demonstrated the
best approach to getting back to work.
Return to Work Impact
What did you as a RTW Coordinator do that led to a positive RTW outcome? How has this impacted your organisation’s overall
return to work culture, outcomes for injured workers and the business itself?
Innovation
How creative, new or different is your RTW initiative/approach?
Transferability
Is there potential for your RTW initiative/approach to be used in other workplaces?
RTW motivation
What motivated you, as an injured worker, to return to work following your injury?
Overcoming RTW barriers
What barriers did you overcome to get back to work following your injury?
Determination
What did you do to remain focused on your return to work? How has returning to work helped you in your recovery following your
injury?