Regional EMS Award for Nurse with Outstanding Contribution to EMS Nomination Form

Regional EMS Award for Nurse with Outstanding Contribution to EMS NOMINATION FORM

  • Read each statement below carefully and answer completely. Limit documentation to the information requested. Up to three documents may be attached to the nomination form. Of these items, one letter of support written by someone other than nominator must be included. Other documents may include a resume or CV, a newspaper article written about the nominee, etc.
  • Drop files here or
  • A.) Why does this nurse exemplify outstanding service in emergency medical services? B.) Describe this nominee’s knowledge and performance of EMS nursing skills. C.) How does this nominee practice high standards of cooperation and leadership with other EMS personnel and agencies?
  • A.) Does this nominee perform a nursing role in a hospital or clinical setting, such as precepting or quality assurance programs? B.) Does this nominee demonstrate excellence as a prehospital provider or instructor? If so, then would this nominee be better suited for one of those categories? C.) Does this nurse sit on any local, regional or state committees?
  • Date Format: MM slash DD slash YYYY