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National Safety in EMS Award

 

Safety in EMS Award Nomination Form

To nominate an EMS agency, please fully complete the nomination form below and attach supporting narrative that addresses the following items:

  1. Describe a process or change that was implemented to correct or improve a safety issue.
  2. Describe any challenges faced by the nominated agency in this effort and how the agency addressed it.
  3. Provide examples of advocacy or leadership by the nominated agency that merit consideration of this award. 
  4. Describe the effectiveness and results of the nominated agency's advocacy or leadership.
  5. Please include any additional supporting documents, pictures or videos.
Note: Nominations will be evaluated based on the extent to which the narrative addresses the award criteria. 
Attach your narrative: *
Attach your file here

Attach up to three (3) supporting documents (optional)

Attach up to three (3) supporting documents (optional)
Attach up to three (3) supporting documents (optional)
Attach up to three (3) supporting documents (optional)