Walter J. Courmon and George W. Burke Safety Awards Application
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Walter J. Courmon Award Description

The Walter J. Courmon Award is awarded to water treatment plants and their distribution systems. The Courmon award was created in 2003 in memory of Mr. Walter J. Courmon, an employee of the City of Greensboro. Mr. Courmon was also an active member of the NC AWWA-WEA and was the Chair of the Safety Committee.

This award is given every year to encourage an active and effective safety program in municipal and industrial water and wastewater facilities. Documented and illustrated safety programs and safety records of the facility for the preceding calendar year are the primary criteria for the award.

George W. Burke Award Description

   This award isgiven to wastewater treatment plants and their collection systems. This award was established in       1982 in honor of George W. Burke, Jr. for his many years of service to the water pollution control field.

 

   This award is given every year to encourage an active and effective safety program in municipal and industrial       water and wastewater facilities. Documented and illustrated safety programs and safety records of the facility       for the preceding calendar year are the primary criteria for the award.

 


Walter J. Courmon and George W. Burke Safety Awards Application

To apply for this award, the NOMINATOR (person making the nomination) should complete SECTION 1 with their information so that they can be contacted with questions. ADDITIONAL SECTIONS should be completed to provide basic and supporting information related to the NOMINEE'S QUALIFICATION for this award.

 

2019 Award Nominations must be completed by Monday, July 1, 2019.

 

If you are completing this application on a computer, resizing the screen to half of its normal width may improve the readability of the online form.

 

   




Nominator Information

Please complete the following information for the person completing this nomination.

 

Organization General Information

Complete the following fields related to the organization being nominated for the award.





Utility Memberships

Please indicate which (if any) the organization has a membership with.



Organization Details 

Each organization applying for this award is required to submit the OSHA Form 300A: "Summary of Work-Related Injuries and Illness" with this application. Please do so in the space provided below. 

For the organization details, fill in numbers in the space provided next to each question.

Organization Safety Programs

Check an answer next to each program to describe the status of each program at the utility.









































































Additional Information

Select “Yes” or “No” to the following questions, and provide further details when prompted to do so.

If additional space is needed, please attach a separate document at the end of this form. You may also use this tool to add any other supporting documents.

Uploading Supporting Documents

If you would like to upload responses to open-ended questions, or additional materials, please convert them to PDF format and merge all documents into a clearly labeled file.

   

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