Great Listener Award nomination form
A team or individual who provides exemplary support to colleagues, or patients, going above and beyond to care for those around them.

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: *


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


7. Your email address: *


8. In more detail, describe why this team or individual should win the Great Listener Award (400 words max):

1. Provide specific examples of how this person or team inspires others and goes beyond the daily tasks required for their role.
2. Who do they impact? Does their behaviour have a positive influence on the team and/or the wider organisation?
3. Why is this person or team deserving of this award? *

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