VA Central California Health Care System


Use this form to recognize a nurse who has gone above and beyond to make a difference.

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* 1. Employee's name:

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* 2. Employee's unit or job:

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* 3. This nomination is for

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* 4. Please tell us how this nurse 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.

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

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* 6. Please tell us your name.

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* 7. Choose the role that best describes you:

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

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* 9. 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: