John Miller Inspiration Award 2016NOMINATION FORM

Nominations may be made by any employee, board member, patient, family member or volunteer of Hamilton Health Sciences at the St. Peter’s Hospital site.

Nominee must work at the St. Peter’s Hospital site. This is an individual award.

Name of person you are nominating:

Name of Nominee

Job Title

Telephone and ExtensionEmail Address

Nominator:

Name of Nominator

Title (ie. employee, volunteer, patient, family member, etc.)

Telephone and ExtensionEmail Address

SignatureDate

On the back of this form, please outline the ways the nominee makes an excellent candidate for this unique award. How does the nominee exemplify “enhancing lives” at St. Peter’s?

Please feel free to attach any additional information that will help to support your submission. (i.e. letter of support, article, picture, etc.)

Please return this form along with any support material toBrittney Pierce by May 2nd, 2016.Your submission will be kept confidential and will only be reviewed by the John Miller Inspiration Award selection committee.

Brittney Pierce

Administration Office Room 0052

St. Peter’s Hospital

88 Maplewood Avenue, Hamilton, ON, L8M 1W9

If you have any questions, please contact Brittney Pierce at ext.12414 or . A member of the planning committee may contact the nominator for further information and/or clarification.

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John Miller Inspiration Award

CRITERIA

Name of Person you are nominating:______

John Miller was a wonderful man. He provided an excellent example of leadership and fostered caring work relationships with staff, patients and board members. John valued lifelong learning and developing and maintaining positive connections/relationships with various individuals and groups.

In the space below tell us about the individual you have nominated and how he/she bringssome of these same qualities to life at St. Peter’s. Consider whether the individual is a positive influence to those around them. For example we would expect that the person you are nominating;

Works well with patients, families and team members and,

At times, goes beyond the call of duty providing care to patients and families

  • Please provide a few examples or a story that illustrates why you think this person should be recognized for this Inspiration Award. Through their daily actions, how do they help to enhance lives at St. Peter’s Hospital?

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