35+ YEAR SAFE MINING AWARD NOMINATION FORM

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2026 • 35+ Year Safe Mining Award

Nomination Form

Use this form to nominate people 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 2026 Conference, scheduled for April 13–15, 2026.

Please complete one form per nominee and return to:

South Central Joint Mine Health Safety Conference
scjmhscassociation@gmail.com

Please send a head shot of the nominee. Nominees must register and attend the conference to receive the award. (Limit: 10 nominees.)

Conference Registration Fee

$375.00 per registrant – includes all meals and refreshments served by the Conference and any sessions or workshops.

Entry Deadline: March 13, 2026

Nominee*
Please enter a number from 35 to 100.
Mine Type*
Person Completing This Form*

If your nominee has received this award previously, they will be ineligible to be nominated again for 5 years.

Guidelines for Applicants:
1) Applicant must attend and will be recognized during the Conference.
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.


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