Online Nomination

What type of nomination / feedback would you like to give ?

If an employees has given exceptional service to you, please let us now by filling in the form below. The Society also has an employe of the month program where an employee is recognised for meeting and displaying our core values. All nominations will be considered for the employee of the month, however if you would like to make a specific nomination for this employee, please indicate below.

Employee of the month nomination

Feedback on a job well done

Nomination - Iris Cribb Bursary

Your Details

Please enter your name:


First name:

Last name:

Compulsory field

Please enter your email address:

Compulsory field

Please enter your phone number:

Compulsory field

The Nominee / Employee

Who would you like to nominate?
Enter the name of the person

Compulsory field

Please explain how the person demonstrated the core value of safety:

Please explain how the person demonstrated the core value of respect:

Please explain how the employee demonstrated the core value of integrity:

Please explain how the person demonstrated the core value of teamwork:

Please enter any other comments in support of the nomination:

Would you like to attach any relevant documents in support of the nomination?:

Document 1:

Document 2:

Maximum size 2MB. Preferred filetype is 'pdf'.
Compulsory field
Privacy Notice
We respect your privacy. Information collected on this form will be used for the purpose of dealing with the nomination. This information may be disclosed to relevant staff, officers, members, suppliers, contractors, affiliates and/or training partners. We may also use information on this forms in public statement or announcements about in respect to the nomination. If your nomination involves a person or a response from a person, that person may view the information you have provided in order to respond. Please contact us if you do not agree with our privacy policy as we may not be able to process your nomination. You will be able to access this information by contacting our Privacy Officer.
Note: certain information from your computer (including your IP address and other identifiers) will be collected when this form is submitted.
Powered by Tectite php form (FormMail).

Information on this form (including your name) may be used by the Society in newsletters, statements, social media posts, annual reports, etc.