Organization Nomination Application Form

Please submit a cover page with the following information:
1. Nominators - include names, titles, organization, full address, telephone, fax and email.
2. Nominees - include organization, organization representative, full address, telephone, fax, email, industrial sector (e.g. mining or forestry), affiliated union(s) and union's phone, fax and email.
3. Organization Awards Category - (select one)
  - Small Organization / Workplace (2 to 500 workers, and may include an independent operating unit of a larger organization) with an internal disability management program
  - Large Private Organization / Workplace (over 500 workers) with an internal disability management program
  - Crown Corporation / Government Agency (over 500 workers) with an internal disability management program
  - Private Sector Service Provider (disability management or return to work)
  - Public Service Initiative by a government or statutory agency.
Outline the reasons for nominating this organization:
1. Describe the personal impact the nominee's disability management program has had on workers with illnesses, injuries and disabilities.
2. Describe the economic impact the nominee's disability management program has had on workers with injuries, illnesses or disabilities, and on the organization.

Show evidence of this organization's success -
Please provide objective evidence and/or outcome illustrations that characterize the success of your nominee's disability management program, as related to the following criteria:
1. Joint Labour / Worker-Management Organization / Workplace Initiatives
  Describe how the nominee has demonstrated strong evidence of joint labour / worker-management initiatives that reflect best practices in disability management.
2. Proactive Disability Prevention
  Describe how the nominee has demonstrated excellence in proactive disability prevention (this may include accomplishments in safety, ergonomics, health promotion / wellness and disability statistical reporting systems that are used to control risks).
3. Disability Management Education and Training
  Describe the nominee's achievements in promoting disability management through labour / worker-management orientations, training seminars or educational presentations in the community.
4. Creative Early Intervention and Return-to-Work Strategies
  Describe how the nominee has demonstrated creativity and achieved positive results through early intervention and return-to-work strategies.
5. Effective Return-to-Work, or Transitional Work, Programs
  Describe the nominee's return-to-work, or transitional work, program, including unique program features, effective policies and procedures, how the program operates and outcomes that benefit workers, the workplace and society.
6. Creative and Effective Worksite Accommodations
  Describe and provide evidence of the nominee's creativity and excellence in implementing effective workplace accommodations that enable workers with disabilities to perform essential job functions safely and productively.
7. Comprehensive Disability Management Program Evaluation
  Describe how the nominee has demonstrated excellence in objectively evaluating quality and measurable outcomes of its disability management program.
8. Fully Integrated Disability Management Program
  Describe how the nominee has demonstrated excellence by establishing a fully integrated disability management program that offers return-to-work opportunities, accommodations and other disability management services to both workers with work-related injuries and those with non-occupational injuries, illnesses or disabilities.
9. Disability Management Benchmarking and Outcome Research
  Describe how the nominee has demonstrated excellence through formal research activities, benchmark surveys or outcome studies that have made a significant contribution to disability management practice in the workplace.