Tell us a bit about you:Please complete ALL sections in FULL in order for your nomination to be considered. If Microsoft WORD asks you for a password to allow editing this document, please note there is no password (empty field). Please click enter/return if a password prompt pops up.

Are you a patient, staff member or member of the public?Patient Staff Public

Your name      

Job title (if staff member)      

Phone number      

Mobile      

Address/work address      

Email      

Details of the individual / team / volunteer you wish to nominate

First name      

Surname      

Department      

Their job role      

Phone number      

Mobile      

Email      

Please mark the award you are nominating with an X (select one only)

Celebrating people who champion the RD&E’s special qualities: Care & Compassion, Teamwork & Always Improving

People’s Award Clinical Recognising people who champion the RD&E

People’s Award Non-ClinicalRecognising people who champion the RD&E

People’s Team AwardRecognising teams who together achieve the extraordinary

People’s Innovation AwardRecognising trail blazers in innovation

In a few paragraphs please tell us why this person or team should win (max 350 words). To give your nomination the best possible chance, please provide the following information: • Answer each of the questions outlined in the relevant category: see page 3 for category information• Provide concrete examples wherever possible• Describe how the person or team has overcome any challenges along the way

     

Lastly, are you happy for us to use this information in publicity material? Yes No

Date      

Where to send your nomination:1 If you are a patient/carer: Please hand it to a member of staff on your ward or department.2 If you are a staff member: Please forward to your Divisional Director or Head of Service.3 If you are a member of the public: Please email to rde-tr.engagement@nhs.net or send to:

Engagement Team (E206), RD&E, Barrack Road, Exeter, Devon, EX2 5DW