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Values in Action Award Nomination

Employee Deposit Slip

Please complete the following form and click on the submit button. Thank you.

*Nominee Name:

Date:

*minimum one year tenure as a WMHS or Trivergent Employee

Nominee's Department/Unit:

Nominator:

Check Core Values consistently demonstrated by this employee:

Integrity

Innovation

Compassion

Accountability

Respect

Excellence

Give examples which set this nominee apart in exhibiting the WMHS Core Values:

Check Service Excellence Standards consistently exhibited by this nominee:

Communicates in ways you understand

Listens to understand your questions and concerns

Responds quickly to physical, emotional, and spiritual needs

Provides a clean, quiet, healing environment

Is warm and sincere in every interaction

Respects patient and coworker confidentiality

Is a positive advocate for WMHS

Strives to continually improve

Cite examples which differentiate this employee in Service Excellence demonstration:

Has this employee contributed to “Meeting the Challenge” of HealthCare Change through efforts to improve processes or care? If so, note efforts here:

Describe specific or sustained accomplishments that exceed normal expectations (Ex. Improves department or organizational culture; Demonstrates fiscal awareness resulting in additional revenue or expense reduction; Prevents a major disaster – clinical, infrastructure, legal liability):

Any additional comments can be attached to the physicial copy of this form. Please submit Nomination Form to Robin Norris in the Human Resources Department. Click HERE to download the form.