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Daisy award graphic

DAISY Award Nomination

Thank you for taking a few moments to nominate a deserving Registered Nurse for the DAISY Award.

Salem Health Values

Excellence | Caring | Integrity | Accountability | Teamwork

 

Daisy Nomination Form


Nominee Information


Nominee First Name
*
Nominee Last Name
*
Where did you encounter the nominee? (Department, unit, hospital area, etc.)
*
Your nominee must excel in four qualities to be considered for the award: Clinical Skills, Compassionate Care, Exemplary Service and Continued Commitment to Excellence. In each of the sections below, please briefly describe examples of why your nominee deserves the Daisy Award.
Clinical Skills
*
Compassionate Care
*
Exemplary Service
*
Continued Commitment
*

Your Information


Your Name
*
Your Phone
*
Your Email
*

Which best describes you ?
Patient
Visitor
Employee
Physician
Other

If Other, please explain
*