The Gail Williams Award for Clinical and Operational Excellence nomination form
This award will be presented to an individual or team who have displayed clinical excellence in the pre-hospital field. This should encompass the delivery of evidence-based practice through clinical analysis, critical thinking and contributing to improved patient outcome.

1. Nominee's name (the one you are putting forward for the award, include all names if nominating more than one person): *


2. Job title(s) and base location(s) of the nominee(s): *


3. Contact phone number(s) of the nominee(s) (mobile preferred otherwise, landline): *


4. Email address(es) of the nominee(s): *


5. Your name and job title: *


6. Your contact number (mobile preferred, otherwise, landline): *


7. Your email address: *


8. List 1-2 other people who may be contacted for additional information about the nominee(s) if they become a finalist (include name, email and/or phone). *


9. How did the nominee(s) demonstrate excellence worthy of recognition? (200 words max) *


10. How has the contribution of the nominee(s) impacted a specific locality, group or community? (200 words max) *


11. What makes this person/team stand out from others doing similar work? Please provide examples beneficial to the nomination (300 words max). *

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