Rainbow Heart Award Nomination Form

This is the Nomination Form for the 2022 Care Awards, specifically for The Rainbow Heart. Please fill it in carefully. It will automatically log your nomination and send an e-mail to our team. You should get a confirmation e-mail, if you don’t get one, email awards@careandsupportwest.com. Or call 07469171626.

Name

This is about you so we understand the source of the nomination and can contact you if necessary.

First Name

Last Name

Your Contact details

If there is no e-mail, please make sure you give us an address or a telephone number here

Nominee

This is the person, team or organisation you are nominating for an Award. It is important that you give us enough information so we can contact them. For example, please make sure you give us either the telephone or the e-mail of your nominee's employer or if they are not employed, your nominee's own contact details.

Nominee's Job Role

This is the nominee's job title or main role

Category of Award

Please select the award you think your nominee deserves.

Nominee's Employer

Employer address

Employer Telephone Number

Employer e-mail

Relationship

My relationship with the nominee is

Personal Qualities

Please could you include an account, story or experience of outstanding care and dedication during the COVID-19 pandemic? You must include a summary of the impact the person has made.

Evidence?

Have you evidence to support this? For example comments from colleagues, managers, service users, family members or other professionals such as GPs, Community nurses, social workers. This is not mandatory.