Safety Star Program Nomination Form

Nominate a Safety Star

Please complete the following form to nominate an employee for the Safety Star program. The form will submit an email to the Safety Council, who will review nominations monthly.  A vote will be taken, majority winner.

  • Nominees must be UC Davis employees.
  • An employee can only win one time per fiscal year.
  • To be considered, an employee must be nominated by another person. One cannot nominate themselves.
  • The act(s) must be work related and have occurred at campus facilities or work related locations.

For information about the Safety Star Program, visit the Safety Star Program Information page.


Nominating Party Information
Nominee Information
Recognition Description