The Daisy Award

1

Nominee's Name* This field is required.PLEASE LIST THE WYANDOT MEMORIAL HOSPITAL EMPLOYEES FIRST AND LAST NAME

First Name

Last Name

2

PROGRESS- HAS THIS NOMINEE MADE WYANDOT MEMORIAL BETTER?* This field is required.

YESNO

3

RELATIONSHIPS- IS THIS PERSON HONEST, RESPECTFUL AND TRANSPARENT?* This field is required.

YESNO

4

OUTCOMES- DOES PERSON OPTIMIZE PROCESSES TO GET THE BEST RESULT?* This field is required.

YESNO

5

MAKE A DIFFERENCE- HAS THIS PERSON MADE A DIFFERENCE FOR PATIENTS?* This field is required.

YESNO

6

INTEGRITY- DOES THIS PERSON DO THE RIGHT THING?* This field is required.

YESNO

7

STEWARDSHIP- IS THIS PERSON A GOOD STEWARD OF RESOURCES?* This field is required.

YESNO

8

EXCELLENCE- DOES THIS PERSON PROVIDE EXCEPTIONAL CARE/SERVICE EVERY TIME?* This field is required.

YESNO

9

Please provide at least 4 sentences elaborating on why/how this outstanding employee deserves to receive this award! Please be as specific possible- specific examples, dates, and details are always appreciated.* This field is required.PROGRESS – Better tomorrow than today- How has this employee made Wyandot Memorial better? RELATIONSHIPS – Honest, respectful and transparent in all interactions- OUTCOMES – Optimize processes to achieve better results MAKE- a difference INTEGRITY – Do the right thing STEWARDSHIP – Responsible use of all resources entrusted to us EXCELLENCE – Exceptional Care, Exceptional Service…Every Patient, Every Time Please provide at least 4 sentences elaborating on why/how this outstanding employee deserves to receive this award! Please be as specific possible- specific examples, dates, and details are always appreciated.

Explain why your nominee deserves the selected award.

10

Your Name* This field is required.PLEASE LIST YOUR FIRST AND LAST NAME

First Name

Last Name

11

Your E-mail Address OR phone number* This field is required.PLEASE ENTER YOUR EMAIL ADDRESS OR PHONE NUMBER

12

Which best describes you status* This field is required.

Wyandot Memorial Hospital Employee

Wyandot Memorial Hospital Retiree

Community Member

Other