Nomination form

Please complete the nomination form and submission template and refer to pages 10–12 of the guidelines for instructions on submitting a nomination. Please ensure the details provided in the nomination are accurate. The wording provided will be used to develop awards documentation. Please be succinct.

……………………………………………………………………………………………………………………………………………………………………………………………………………

This nomination is for:

☐ an initiative ☐ a team ☐ an individual

……………………………………………………………………………………………………………………………………………………………………………………………………………

In the category of:

☐ customer focus ☐ fostering innovation ☐ excellence in performance ☐ courage and integrity ☐ excellence in leadership

……………………………………………………………………………………………………………………………………………………………………………………………………………

Where an initiative, team or individual is being considered across multiple categories, separate nominations addressing the specific category criteria must be submitted.

Agency details / Additional agency involvement
Name of nomination / Is more than one agency involved in the nominated
initiative? ☐ Yes ☐ No
Name of initiative (if applicable) / If yes, please list each additional agency involved in the
nomination and include a separate nomination form.
Name of work unit/team/individual / 1.
2.
Name of agency / 3.
Name of department / Agency contact person responsible for nomination
Name
Address
Position
Estimated number of team members / Email
Agency website/initiative webpage address
Phone
Declaration
I, the Director-General/Chief Executive Officer of the agency:
☐ submit this nomination in accordance with the 2015 Premier’s Awards for Excellence guidelines
☐ acknowledge and agree this nomination will be governed by the conditions contained in the guidelines.
Name / Position
Signature /

Submission template

1. Project description

Provide a brief overview (maximum 200 words) of the initiative, team or individual including the purpose, key outcomes and achievements. This overview may be included in award collateral.

2. Nominees

Provide a list of names and position titles for each member or individual who was working in the team or on the initiative at the time of nomination. An email address is required for the primary contact.

Primary Contact / Position / Email
Team Members / Position

3. Key achievements and outcomes

  • Include quantitative and/or qualitative data and information specifically relevant to the achievements and outcomes of the initiative, team or individual.
  • Comparative data is highly desirable to demonstrate the effectiveness of outcomes.
  • Provide evidence of the extent to which the aims and objectives were accomplished, details of the evaluation methodology and the planned future directions.
  • If a nomination has links to other categories this should be addressed.
  • This section should not exceed two pages.

4. Response to criteria

  • Directly address the award category criteria relating to the initiative, team or individual.
  • Consider benefits to both the department and the state.
  • The criteria should be addressed here, not in the supporting documentation.
  • This section should not exceed three pages.

5. Referees

Provide the names and contact details of two referees representing the clients or key stakeholders of the initiative, team or individual who agree to be contacted by the selection panel to support this nomination if deemed necessary. The referees should ideally be external to the agency and familiar with the nominee’s work. The referee should not be a team member or project supervisor.

Name
Organisation
Position
Phone
Email
Name
Organisation
Position
Phone
Email

6. Supporting documentation

  • If appropriate, provide any supporting materials relevant to key aspects of the nomination that demonstrate the achievements of the initiative, team or individual.
  • Newspaper articles, letters of appreciation or publicity photos can be scanned and inserted as an image below.
  • Please only provide links to videos if applicable.
  • This section should not exceed four pages.

Video Link
Video Link
Video Link

Please insert images below and resize as required.

7. Photos

  • If appropriate, provide a selection of up to five relevant photos.
  • Action shots are preferred.
  • Please copy and paste your images below.
  • This section should not exceed two pages.

Please insert images below and resize as required.

Checklist

☐ completed, signed nomination form/s

☐ project description (maximum 200 words)

☐ nominee details

☐ key achievements and outcomes

☐ response to criteria

☐ referee details

☐ supporting documentation (if appropriate)

☐ selection of up to five photos

Please ensure your nomination does not exceed 15 pages (including the nomination form) and is saved as a single Word or PDF document.

Nomination submission

Nominations close 5 pm Monday 31 August 2015.

Nominations can be submitted electronically as a single Word or PDF document via email to: .

Alternatively, nominations can be submitted on a USB or CD/DVD, delivered via post or in person to:

Awards Coordinator

2015 Premiers Awards for Excellence

Events Coordination

Department of the Premier and Cabinet

Postal address:

PO Box 15185

CITY EAST QLD 4002

Hand delivery address:

Level 2, Executive Building

100 George Street

BRISBANE QLD 4000

Courier delivery address:

Events Coordination

Level 2, Executive Building

100 George Street

BRISBANE QLD 4000

c/-DECIPHA

2 Duncan Street

West End QLD 4101

Information and enquiries

General enquiries regarding the awards should be directed to or telephone 07 3003 9200.