Please complete all the required information below and return to healthrecognition@ucsf.edu or Box 1299.
Nomination Statement
Minimum of 200 words.
TIPS for writing a strong nomination:
Give evidence to support your statements about the nominee. Use specific examples and be clear and
concise.
Quotes/statements contributed by co-workers, supervisors, faculty and patients are encouraged in your
nomination.
Make sure not to disclose any HIPAA protected confidential information, i.e. patient information or other
identifiers.
Please provide a specific story or example(s) of how this nominee goes above and beyond to
create an optimal work experience for their colleagues and/or create a great experience for a
patient or patient’s family member.
Please explain how this nominee embodies at least one of the PRIDE Values through the
above story/example(s).
A compelling story or example(s) should be heartfelt and describe how this person make you or others feel.
Your Name
_________________________________________________________________________
Your Email
_________________________________________________________________________
Name of Nominee
Only UCSF Health (including BCH Oakland) employees are eligible.
________________________________________________________________________
Nominee’s Supervisor
List your best guess or refer to the UCSF Health roster in the HR Umbrella. BCH Oakland roster available upon request.
_____________________________________________________________________
Nominee’s Affiliation
Please check one.
UCSF Health
BCH San Francisco
BCH Oakland
Nominee’s Job Category
If you are unsure, select your best guess.
Clinical Coordination
Clinical Support
General Administration
General Services
Healthcare Specialists
Management
Nursing
Technologists & Technicians
INDIVIDUAL
NOMINATION FORM
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________