The Warrington and Halton Hospitals NHS Foundation Trust Staff Awards

Thank You Awards 2015 nomination form

The Thank You Awards are our annual staff awards events where patients, public and fellow staff members can nominate any member of staff at Warrington and Halton Hospitals for an award. We’d love it if you could take the time to nominate a member of staff who has gone the extra mile for you if you have been a patient, carer or relative at our hospitals.

Please use this form to nominate staff for the Thank You Awards. Give us as much information as you can. There are seven categories in the awards ranging from volunteer of the year through to employee of the year, but we’ll put your entry into the most relevant category.

Don’t worry if you don’t have full details of the person you want to put forward – even if you just have a first name or location we can usually track them down!

We need your entries back in by 23rd November 2015 please.

1. Details of the nominee

Name of the individual or team you wish to nominate:

Please give the details of the individual you are nominating so we can contact them (or as much information as you have if you’re not sure):

2. About you (the nominator) - Please give us some details about yourself:

We think it’s really important that staff know when their dedication and excellence is recognised even if they don’t receive the award. We would like to tell staff that you have nominated them.

If you would rather remain anonymous please tick or out an x next to the box

3. Why your nomination should win this award

We need to know why you think that the emplyee or team that you are nominating should win. We need as much information as you can provide. The criteria below will be used to assess the applicants. The more information you give us the easier it is for us to identify why they should win!

How the staff/team consistenly gave an exceptional service?

Can you give us some examples of why the service is exceptional?

Was the service you received beyond that you would normally expected?

What made the service you received so special?

Were you impressed by the positive approach and attitude to work of the member of staff/team?

Can you give us some examples of their approach and how this made a difference to you?

Did you see the member of staff/team show exceptional commitment to others?

What did they do that demonstrated this quality?

How did the actions of the member of staff/team make a difference?

Can you give us an example?

Any other information you want us to consider?

4. Returning your entries

That’s all the information we require for now!

Please save or print the form and then return your nomination forms to:

By Email -

By Post - Staff Engagement & Wellbeing Team, HR Department, Warrington Hospital, WA5 1QG

If you have any questions at all, don’t hesitate to contact:

· 01925 664210