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DAISY Award Nomination Form

Nominations for the DAISY award are for nursing staff and based on Lakes Regional Healthcare's "CARES" service excellence standards, which include communication, attitude, responsiveness, and engagement. All nominations are blind and sent to an internal committee to select the recipients. Thank you for completing this nomination!
1.What is the employee's first and last name?(Required.)
2.What department/area does the employee work in?
3.Please describe a specific situation or story that clearly demonstrates how the team member impacted your stay, visit, or work at Lakes Regional Healthcare by providing exemplary service or going above and beyond the normal scope of their position.(Required.)
4.What is your name (first and last name)?(Required.)
5.What is your phone number?(Required.)
6.What is your email address?(Required.)
7.Please check the option(s) that best describe you:(Required.)
Thank you for nominating one of our team members! The person you nominated will receive a copy of this nomination to know the impact they made on you and the difference they have made. They will also receive a special note from hospital leadership.

If the person you nominated is selected for the award, we may likely contact you to participate in the award ceremony.

Thanks again!