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

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