SLSQ Lifesaving Excellence Award

Nomination for

Nominee Name 1

First NameLast Name

Nominee Name 2

First NameLast Name

Nominee Name 3

First NameLast Name

Nominee Name 4

First NameLast Name

If there are any extra nominees for the rescue, resus, leadership or contribution to lifesaving, please use the below space to add the names.

Is the nominee(s) aware they are being nominated?

Was there a member of the public involved and nominated?

If so, who was the member of the public nominated?

Nominee/s Club/Service

if applicable, if multiple clubs please list

Branch

Location of Incident

LIMSOC incident number

if applicable or known

Date of incident

Date

Time of incident

Hour Minutes

AM/PM Option

Provide a description of the incident

Please outline the skills and resources utilised

Is there anything that could be improved or better utilised in future?

Environmental Conditions

When responding to the rescue or resus, was their any environmental conditions that needed to be taken into account? Eg. was the incident around rocks, cliffs, or other precarious situations, size of surf, wind, visibility, time etc.

Attach relevant supporting documents

Would you like this SLSQ nomination to be put forward for an SLSA Meritorious Award or SLSQ Bravery Award?

What award category would you like SLSQ to choose?

Do you acknowledge that if the person(s) nominated was apart of SLSQ in some form, they are current in Surfguard as a club member, ALS employee or a lifesaving service?

Do you acknowledge that if the person(s) nominated was apart of SLSQ in some form, they are proficient in the relevant awards that are required to perform the tasks listed in the incident response?

Did the club complete one or more of the following supporting documentation? Please select any that are relevant.

Has your relevant Branch Director of Lifesaving been informed of the nomination? (excluding lifeguards)

Nominator Name

First NameLast Name

Nominator Contact Email

example@example.com

Nominator's Mobile number

Please enter a valid phone number

Signature acknowledge