About you (*indicates a required field)

*Name: / *Telephone number:
*Address:
*Postcode:
Email address:
*Are you a… (please tick) Member of staff / Member of the public/patient

About your nomination

*Who are you nominating?

*In which category are you nominating (please tick one only). See overleaf for an explanation of the categories and what the judges will be looking for.

Tick / Tick
Volunteer of the year award / Patient care (team) award
Service improvement (individual) award / Employee of the year award
Service improvement (team) award / Safer hospitals award
Patient care (individual) award / Fundraiser of the year (team or individual) award

*Give your reasons for nominating this individual or team - please use no more than 500 words.

Once completed, return it before midnight on 9 February 2015 by:

  • Handingit in at any reception desk at Poole Hospital
  • Emailing it to
  • Postingit to: Communications, Poole Hospital, Longfleet Road, Poole, BH15 2JB

Thank you

Category / Description / Judging criteria (all or some may be relevant)
Volunteer of the year award / Awarded in recognition of an individual who has given their time or skills freely and consistently in order to make a positive contribution to hospital staff and/or patients / An outstanding individual
Has made an exceptional contribution to patients or staff
Has contributed skills or time
Promoted a positive impact on the service, team or patients they support
Embodies the Poole Approach - a friendly professional, patient-centred contribution, preserving dignity and respect for all
Reliable and highly valued
Service improvement (individual and team) awards / Awarded in recognition of a clinical or non-clinical individual or team’s contribution to improving service quality, patient experience and/or introducing and sustaining innovative ways of working / Made an outstanding contribution to improving services for patients and/or colleagues
Has achieved demonstrable results
Service improvements are sustainable
Has identified where an improvement can be made and taken a planned and systemic approach to delivering this
Engages with, and is responsive to, the needs of service users, including patients and/or colleagues
Patient care (individual and team) awards / For outstanding individuals or teams who have consistently met or exceeded the expectations and needs of our patients / Embodies the Poole Approach - a friendly professional, patient-centred contribution, preserving dignity and respect for all
Demonstrates consistent high standards in kindness, compassion, communication and care
Goes the ‘extra mile’
Is supporting and encouraging of others
Embraces and follows the Golden Rules
Improves the patient experience, though not necessarily in a care-giving role
Employee of the year award / An individual in a clinical or non-clinical role who has made an outstanding contribution to their colleagues, team, patients or organisation. / Has made an outstanding contribution to their team, service or organisation
Viewed by others as a positive influence
Demonstrates leadership/ownership of tasks and issues
Consistently high-performing
Makes time for others
Consistently applies the Poole Approach - a friendly professional, patient-centred contribution, preserving dignity and respect for all
Safer hospitals award / Made in recognition of an individual who ensures patient safety is at the heart of what they do. / A patient safety champion
Their actions have reduced harm or untoward incidents directly
Supported or directly contributed to high standards of clinical hygiene/cleanliness
Improved health outcomes for patients
Has made their working environment safer for staff and/or patients
Safeguards patient privacy
Fundraiser of the year (team or individual) awards / Awarded in recognition of an individual or team that has made an exceptional contribution to fundraising for PooleHospital to benefit staff and/or patients. / Has made an outstanding contribution by supporting the Trust to deliver even better services to patients
Their fundraising has been a significant achievement; in terms of one or more of the following:
time, effort, money, ingenuity or resourcefulness
Has inspired others to support the hospital’s fundraising endeavours

Stay up-to-date with the Poole Hospital Awards 2015, orcomplete this form online, at and click the front page awards link