	Required Field
Nominee:
First Name: First Name is required.
Last Name: Last Name is required.
Job Title: Job Title is required.
Company/Organization: Company/Organization is required.
Email: Email is required. Email is invalid.	Ex: someone@somewhere.com
Phone: Phone is required. Phone is invalid.	Ex: (317) 555-1234 or 555-1234
Address: Street Address is required.
City: City is required.
State: State is required.
Zip: Zip is required. Zip is invalid.	Ex: 12345-6789 or 12345
County: County is required.
Nominator:
First Name: First Name is required.
Last Name: Last Name is required.
Job Title: Job Title is required.
Company/Organization: Company/Organization is required.
Email: Email is required. Email is invalid.	Ex: someone@somewhere.com
Phone: Phone is required. Phone is invalid.	Ex: (317) 555-1234 or 555-1234
Address: Street Address is required.
City: City is required.
State: State is required.
Zip: Zip is required. Zip is invalid.	Ex: 12345-6789 or 12345
County: County is required.
In order to be considered for a Commissioner's Award of Excellence, please address the following:
Fully describe the exemplary achievements or efforts displayed by the nominee including persons involved, time invested and what was specifically accomplished through the nominee's efforts. This field is required.
How did this effort or achievement further advance the safety, health and prosperity of Hoosiers in the workplace? This field is required.
List any additional information you deem appropriate which further qualifies the nominee.
Upload any additional supporting documentation you feel should be considered.	File types accepted: Microsoft Word and Excel, PDF, and Word Perfect. Maximum file size is 5MB. If you have more than one file to attach or your file exceeds 5MB, please zip your file(s) to reduce the size to under 5MB. If the files are too large to be uploaded when zipped, please email them to insafe@dol.in.gov.