2. The City of Coon Rapids uses a nomination and award system to recognize employees who identify significant improvements to workplace safety! The suggestion must be implemented and centered on reducing workplace injuries and enhancing the safety of our workplace.

   Nomination may be made by co-worker(s) or manager/supervisor of the City of Coon Rapids.

   All forms are submitted to Mena Lee for consideration.  All submitted nomination forms will be reviewed by the Safety Committee.

4. Nominee's Name:
6. Nominee's Job Title:
8. Nominee's Department:
10. Nominee's Supervisor Name:
12. Nominator's Name:
14. Nominator's Job Title:
16. Reason for Nomination:

    Please describe in detail how the nominee has suggested and implemented a process that saves workers from injuries or that could potentially save lives. 

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17. 1. Receive an email copy of this form.
18. Email address

    This field is not part of the form submission.

19. Submit Submit and Print

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