Regional EMS Award for Outstanding Contribution to EMS Health & Safety Nomination Form

Regional EMS Award for Outstanding Contribution to EMS Health and Safety NOMINATION FORM

  • Examples of programs meeting eligibility for this award would include EMS provider health and wellness programs (fitness and wellness, cardiovascular health), scene safety programs (aeromedical operations, emergency vehicle operations), and provider injury prevention programs (injury prevention at violent scenes) designed to prevent line of duty death and injury. Eligible applicants include persons or entities developing or managing such programs.
  • If nominating an agency, please include the agency license number here.
  • 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
    Max. file size: 100 MB, Max. files: 3.
    • A.) Why does this program/accomplishment deserve to be recognized? B.) Describe the accomplishment/program, including its objectives and clientele being served and how it contributes to or provide for the health, safety and welfare of EMS providers.
    • A.) How were the objectives met? B.) Provide examples and outcome measurements when possible. C.) Give detailed results analysis of the program.
    • Accepted file types: jpg, jpeg, png, gif.
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