SLSQ Lifesaving Excellence Award
Nomination
Nomination for
*
Outstanding Rescue
Resuscitation
Leadership
Contribution to Lifesaving
Nominee Name 1
*
First Name
Last Name
Nominee Name 2
First Name
Last Name
Nominee Name 3
First Name
Last Name
Nominee Name 4
First Name
Last 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?
*
Yes
No
Was there a member of the public involved and nominated?
*
Yes
No
If so, who was the member of the public nominated?
Nominee/s Club/Service
*
if applicable, if multiple clubs please list
Branch
*
Please Select
Point Danger Branch
South Coast Branch
Sunshine Coast Branch
Wide Bay Capricorn Branch
North Barrier Branch
North Queensland Branch
Brisbane Lifesaving Service
Location of Incident
*
LIMSOC incident number
*
if applicable or known
Date of incident
*
/
Day
/
Month
Year
Date
Time of incident
*
Hour Minutes
AM
PM
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
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Would you like this SLSQ nomination to be put forward for an SLSA Meritorious Award or SLSQ Bravery Award?
*
Yes, SLSA Meritorious Award
Yes, SLSQ Bravery Award
Yes, both the SLSA Meritorious Award & SLSQ Bravery Award
No thank you
What award category would you like SLSQ to choose?
*
Please Select
Individual Award
Group or Club Award
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?
*
Yes
No
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?
*
Yes
No
Did the club complete one or more of the following supporting documentation? Please select any that are relevant.
Incident Report Log
Supporting statements (e.g., Police, Ambulance, Public Witness Statement)
Information or reports of rescues from media agencies
Copy of the patrol log (where applicable)
Has your relevant Branch Director of Lifesaving been informed of the nomination? (excluding lifeguards)
*
Yes
No
Nominator Name
*
First Name
Last Name
Nominator Contact Email
*
example@example.com
Nominator's Mobile number
*
Please enter a valid phone number
Signature acknowledge
*
Submit
Should be Empty: