VA Central California Health Care System

Use this form to nominate an employee who has gone above and beyond to make a difference in your life.

Question Title

* 1. Employee's name:

Question Title

* 2. Employee's unit or job:

Question Title

* 3. Please tell us how this employee demonstrated at least one of VA's I CARE values:

Integrity: Maintains the trust and confidence of all with whom she/he engages.

Commitment: Serves Veterans and their families by honoring the VA’s mission.

Advocacy: Truly focuses on serving the Veteran.

Respect: Provides dignity and respect to everyone she/he serves and encounters.

Excellence: Strives for the highest quality and continuous improvement.

Question Title

* 4. Please share your story of what this employee's actions meant to you (250 words or less):

Question Title

* 5. Please tell us your name.

Question Title

* 6. Choose the role that best describes you:

Question Title

* 7. How you would like to be notified if the employee you are nominating is selected for a DAISY Award?

Question Title

* 8. Nurses who are nominated receive an official DAISY nomination certificate, a DAISY Nominee pin, a copy of your nomination, cinnamon rolls, and an in-person celebration on their unit with hospital leadership. All other staff who are nominated are submitted for VACCHCS Incentive Awards and receive a certificate and promotional item and are invited to receive their awards at the in-person hospital-wide monthly Incentive Awards ceremony.

If you would like to share any comments, please do so in the box below:

T