CARE Award

Nomination Form

The CARE Award Recognition program has been established at the
Punxsutawney Area Hospital to promote and highlight the extraordinary
efforts of members of our workforce. PAH recognizes that being a successful
organization and providing the best care possible to our patients is a
collaborative effort.

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* 1. What is the name of the staff member would like to recognize? (First and Last if possible)

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* 2. What department does this staff member work in? (Rehab, Radiology, Housekeeping, Etc.)

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* 3. Share your experience or observation of extraordinary, compassionate care being provided by a staff member or how you witnessed a staff member performing their job in an exemplary manner.

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* 4. Nominator's Info

Name

Address

CIty/Town

Zip/Postal Code

Country

Email Address

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* 5. I am a (please check one)

Patient

Visitor

Staff Member

Other (please specify)