ACEM Foundation Sustainability Award

ACEM Foundation Sustainability Award
Form No: F1007

Last Revised: April 2026

Version: V1

Note: If you need assistance filling this form or would prefer to submit a written application, please contact foundation@acem.org.au.

For further information about the award, refer to the ACEM Foundation Sustainability Award Policy.
Are you nominating an individual or group?
Nominee (Individual)
To be eligible for the ACEM Foundation Sustainability Award (individual), the nominee must be an ACEM Fellow, Associate member or FACEM Trainee who is of good standing with the College and demonstrates leadership and innovation in advancing socially responsible, sustainable and environmentally conscious practice within emergency medicine.
Name of nominee

First NameLast Name
Contact number of nominee
Please enter a valid phone number.Format: (000) 000-0000.
Email of nominee
example@example.com
Role of nominee
Nominee (Group)
To be eligible for the ACEM Foundation Sustainability Award (Group / ED), the nominee must be either:
- an emergency department; or
- a group comprised of ACEM members, not necessarily from the same ED;
located in Australia or Aotearoa New Zealand, and demonstrates leadership and innovation in advancing socially responsible, sustainable and environmentally conscious practice within emergency medicine.
Name of emergency department or group:

- The nominator must be an ACEM Fellow, Associate member or FACEM Trainee who is of good standing with the College (please refer to policy P1006 for further details).
- Nominator name
  
  First NameLast Name
- Nominator email
  example@example.com
- Nominator ACEM ID
- Role of nominator
- At what emergency department?
- In what capacity are you familiar with the nominee?
- Nominator signature
- Date
  
  DayMonthYear
  Date
- Seconder details
  
  These details will be used to notify your seconder to complete their section of this form. The seconder must be an ACEM Fellow, Associate member or FACEM Trainee who is of good standing with the College.
- Seconder name
  
  First NameLast Name
- Seconder email
  example@example.com
- Supporting evidence
- Nominations for the award will be assessed according to the extent to which the individual’s and/or group/ emergency department’s initiative demonstrates evidence of;
- Development and implementation – The extent to which an initiative has been effectively developed and implemented within an organisation to advance quality, socially responsible and environmentally conscious practice in emergency medicine. This may include initiatives delivered through clinical practice, education, research or advocacy and should demonstrate clear planning, stakeholder engagement, and integration into clinical, operational or organisational activities.
- 0/500
- Leadership and Innovation – The extent to which leadership and innovation are demonstrated in the conception, development, and implementation of the initiative, and the extent to which the initiative itself represents an innovative approach. Consideration may be given to originality and problem-solving and how the initiative contributes to advancing sustainable clinical practice and cultural change.
- 0/500
- Collaboration – The extent to which the initiative demonstrates effective partnerships with Indigenous leaders, communities, and healthcare teams across local, regional, and national levels. Consideration may be given to the integration of local knowledge and cultural values, collaborative problem-solving, and collective action to advance quality, sustainable, equitable, and resilient emergency care practices.
- 0/500
- Long term sustainability – The extent to which the initiative is viable and sustainable over the longer term, including its capacity to be scaled, replicated or embedded within standard practice. Consideration may be given to resource requirements, ongoing feasibility, and alignment with organisational priorities.
- 0/500
- Impact and outcomes – The extent to which the initiative has addressed challenges, achieved its intended outcomes, or created a positive impact. Include details of how the initiative was evaluated and the methods used to measure its impact.
- 0/500
- Alignment with ACEM Foundation purpose and ACEM publications:
  
  Environmental sustainability practices in emergency departments
- 0/300
- Summary
- Please provide a written statement of no more than 300 words, summarising the information provided. If the nomination is successful, this statement will inform the presentation of the award at the designated ACEM event.
  
  0/300
- Submission
- For further information about the award, refer to the ACEM Foundation Sustainability Award Policy P1006.
  
  Nominations for the ACEM Foundation Sustainability Award must be received by the closing date advertised on the ACEM website.
- The seconder must be an ACEM Fellow, Associate member or FACEM Trainee who is of good standing with the College (please refer to policy P1006 for further details).
- Seconder name
  
  First NameLast Name
- Seconder ACEM ID
- Seconder signature
- Date
  
  DayMonthYear
  Date
- Submission
- For further information about the award, refer to the ACEM Foundation Sustainability Award Policy P1006.
  
  Nominations for the ACEM Foundation Sustainability Award must be received by the closing date advertised on the ACEM website.
- Should be Empty:

Rows	Name	Phone number	Email
Contact 1
Contact 2
Contact 3

ACEM Foundation Sustainability Award

Nominee (Individual)

Nominee (Group)

Seconder details

Supporting evidence

Summary

Submission

Submission