Nomination Form for Trust Values Awards

Please help us celebrate those members of staff who demonstrate our Values in an exemplary way by making a nomination.

* Questions with an asterisk are mandatory - you will not be able to submit your nomination without completing these fields.

Nominated individual or team
Name of nominee*
First Last
Team*
Place of work:*
Job / role (e.g, nurse, doctor, admin, porter etc)*
Division/Directorate (if known):
Line Manager (if known)
Nominee telephone number
Nominee email
Nominator details
Nominated by:*
Nominator name:
First Last
Contact number for further info:*
Email for feedback:*
Enter Email Confirm Email
Details of nomination:
Please select the value you are nominating the individual or team for:*
- Excellent
- Kind
- Responsible
- Respectful
Reasons for nomination*
Please be really specific about why you think your nominee deserves this award. Give at least one example where this individual or team has demonstrated one or more of the trust’s values, where they have gone above and beyond the call of duty, for example.

Anticipate and respond to patients’ and carers’ concerns and worries
Support each other under pressure and consider the impact of our actions on others
Help people find their way if they look unsure or lost
Smile, listen and be friendly

Keep patients, families and carers involved and informed
Protect patients’ dignity and confidentiality
Wear our name badges, introduce ourselves and address people in a professional manner
Respect colleagues’ roles in patient care and experience
Value and understand the diversity of those around us

Nominated individual or team