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2023 Outstanding Contribution to Improving Patient Safety Nomination Form

Category: Outstanding Contribution to Improving Patient Safety

This award is open for public and staff nominations and will be awarded to a team or individual that has made a significant impact upon improving quality in their work area or for the organisation.

The nominee will demonstrate the CityCare values of KINDNESS
For more information about CityCare’s values please visit the website https://www.nottinghamcitycare.nhs.uk/about-us/who-we-are
Your details:
1.Your name:(Required.)
2.Your job title:
3.Your telephone number:(Required.)
4.Your email address:(Required.)
5.Your directorate (if a member of CityCare staff):
About the person or team you are nominating:
Please give the details of the person or team you are nominating
6.Name of the individual or team you are nominating:(Required.)
7.Job title or team name:(Required.)
8.Where is the individual or team based? (if they are split across bases, please give the base where they spend most of their time)
9.Their directorate / Director
10.Telephone:
11.Email:
Evidence for your nomination:
12.Please provide a supporting statement of why you are nominating them, including how they demonstrate the CityCare value of Kindness totalling no more than 150 words.(Required.)
13.The nominee / team inspires me to nominate them because:
Please provide a brief statement of no more than 150 words.(Required.)
14.Are you happy for your nomination to be shared with the person / team you are nominating?