* 1. I would like to nominate (NAME) as a deserving recipient of The DAISY Award. This nurse’s clinical skill and especially her/his compassionate care exemplify the kind of nurse that our patients, their families, and our staff recognize as an outstanding role model.

* 2. Please describe a situation involving the nurse you are nominating that clearly demonstrates he/she meets the criteria for The DAISY Award:

* 3. Thank you for taking the time to nominate an extraordinary nurse for this award. Please tell us about yourself, so that we may include you in the celebration of this award should the nurse you nominated is chosen.

* 4. I am (please check one):

* 5. If staff, please specify unit:

Thank you for nominating a Magee nurse for the DAISY Award.