CQ Health Community (People's Choice) Award Nomination Form 2021 - Page 1 of 4 - Central Queensland Hospital and Health Service

Nomination:

Do you know a hospital or health staff member or team who have done a great job or gone above and beyond? Say thanks by nominating them for the People’s Choice award.

If you need help with completing this form call 4920 7984 Monday to Friday 8am to 4pm for help.

Date and time of experience:

Date:

Day
-

Month
-

Year

Time:

Staff member or team name:

(Required)

Job title and department:

(Required)

Example: Nurse on Ward 1, Doctor on Medical Ward, Cleaner on Emergency Department, Wards person on Maternity.

Facility or service:

(Required)

Example: Community Health, BreastScreen, Mental Health, Cancer Care, Hospital, Aged Care.

Location of your visit:

(Required)

Other, please specify:

Why are you nominating this person or team and how have they made an impact on you or your experience with us?