DAISY Award Nomination Form

Thank you for taking the time to nominate an extraordinary nurse for this award. If you have any questions, please contact Laura Hawley at (530) 274-6799.

Questions that require an answer are marked with  *
* Name of Nurse:
* Unit/Department in which the nominee works:
* Please describe a situation involving the nurse you are nominating that clearly demonstrates they meet the criteria for the DAISY award.
* Please tell us about yourself, so that we may include you in the celebration of this award should the nurse you nominated be chosen.

Your Name:
Your Unit (If you're on hospital staff):
* Phone Number:
Pager Number:
* Email Address:
* I am: