Nomination Forms
for Employee of the Month, DAISY Award, and
Resident of the Quarter

Please complete the form below Employee of the Month Pinto submit a nomination online for one of the following programs: the Employee of the Month, the Resident of the Quarter, the DAISY Award. Your nomination will be sent directly to either the Employee of the Month committee, the Resident of the Quarter Committee, or the DAISY Award Committee.

Employee of the Month / Resident of the Quarter
The Employee of the Month and Resident of the Quarter programs provide a mechanism to recognize and reward employees/residents for performance and active participation in quality Service Excellence. All employees/residents are eligible to be nominated. Each employee/resident selected will be eligible for consideration as Employee of the Year/Resident of the Year.

The Daisy FoundationDAISY Award
The DAISY Award is given each month to an extraordinary nurse at All Children’s Hospital. An extraordinary nurse must have these traits: compassion, provide excellent clinical care, be an advocate for the child and family, use sound judgment, be sensitive to cultural needs, work well with others on the health care team, communicate well with the child and family members, keep the child and family up to date about their care, and educate the child and family so that they understand the illness and treatment.

Nomination Form

Nomination Program * 
DAISY Award (nurses only) 
Employee of the Month (any employee) 
Resident of the Quarter 
Nominee's First Name * 
Nominee's Last Name 
Nominee's Department * 
What shift was this person working? * 
Day Shift 
Night Shift 
Reason for Nomination
(The more details you tell
us about the nomination,
the better chance your
nominee has of receiving
the award.) * 
Nominated By * 
Type * 
a. Family 
b. Patient 
c. Employee 
d. Physician 
e. Visitor 
f. Volunteer 
g. Other 
If Other   
(Please Specify) 
Email Address
(If you would like
a confirmation) 
* Required