35+ YEAR SAFE MINING AWARD

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2025 35+ YEAR SAFE MINING AWARD NOMINATION FORM

Use this form to nominate persons within your organization that have worked 35+ years consecutively, without a Lost Time Injury. The recipients will be recognized and presented with an award.  The nominee will be recognized on the SCJMHSC website and during the 2025 Conference. The Conference is scheduled for April 7-9, 2025. Please complete one form for each nominee**and return to: South Central Joint Mine Health Safety Conference scjmhscassociation@gmail.com. Please send a head shot of the nominee. Nominee must register and attend the conference to receive the award. (Our limit is 10 nominees) 

Miners that have daily duties in the plant and/or field and are exposed to the hazards of the mine will be given preference. Office workers will be eligible for the balance of the 10 awards not earned by plant/field Miners. Office workers will be required to comply with the instructions above.

Entry Deadline is March 7, 2025

"*" indicates required fields

This field is for validation purposes and should be left unchanged.
Nominee*
Address*
Please enter a number from 1 to 100.
Please Give Details Why Nominee Should Be Considered. THE DEADLINE TO SEND THIS FORM IN IS MAR 13, 2026.
Accepted file types: jpg, jpeg, png, gif, Max. file size: 6 GB.
Please upload a head shot of the nominee. This is required to receive the award. You can use your phone to take a picture and upload it directly.
Person Completing This Form*
Attestation & Acknowledgment*
**If your nominee has received this award previously, s/he will be ineligible to be nominated again for 5 years.**

Guidelines for Applicants:
1) Applicant must attend and will be recognized during the Conference. The 2026 Conference is scheduled for APRIL 13 – 15, 2026.
2) Applicant must be a full-time miner that has daily duties in the mine process areas
3) Years of service may be from two or more sites

**Our limit is 10 nominees.**

For more conference details, visit our website at: http://www.scjmhsc.org

Per registrant – includes all meals & refreshments served by the Conference and any sessions or workshops

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