AMP Hard Hat Safety Award Nomination Form

Please enter your information below and click the "Submit Form" button to complete your nomination form.
All fields are required.

If you have questions, please contact Amanda Smithey at asmithey@amppartners.org or 937.797.1595.

*Submissions due May 30, 2025.

Utility name

Name of employee being nominated

Title of employee being nominated

Explain how the nominee has contributed to safety.

Your name

Your title

Address

Phone

Email address (must include @ symbol)

Verification