Nomination Form - Closing 5 pm Friday, 26 April 2019

We encourage nominations from regional, rural and remote areas.

This award recognises a team (more than two people) working within the palliative care sector that has demonstrated outstanding performance and outcomes due to the group effort; innovative ideas or initiatives to improve outcomes; an environment that encourages workplace diversity; positive work culture; collaboration with other departments or services; or increased resilience to operate under challenging circumstances.
This award is open to teams working in the palliative care sector, including palliative care units, hospices, hospitals, aged care, disability, volunteer organisations, community services or groups, or home care.

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* 1. Details of the Team

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* 2. Provide a brief background of the team and the area in which it works

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* 3. Why do you consider this team to be a worthy recipient, recognised by this statewide award?

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* 4. How has this team demonstrated passion, commitment and excellence to their field of work as outlined in this category?

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* 5. Details of the Nominator

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* 6. Has the team granted consent for their nomination?

DECLARATION
I attest that all the information provided on this form is accurate and true to the best of my knowledge.

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* 7. Name

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* 8. Date

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