Sample Employee Of The Month Peer Nomination Form printable pdf download

Sample Employee Of The Month Peer Nomination Form

NOMINATION FOR

EMPLOYEE OF THE MONTH

“U ARE THE ESSENTIAL LINK”

Patient Coordination

1. Any Employee of Patient Coordination; Hospital Operators or Appointment Center

staff may be nominated. The Employee Recognition Program will run from July

to July each year.

2. Any Patient Coordination staff personnel may initiate the nomination process by

filling out the nomination form and then placing nomination form in the office

manager’s area in nomination file box. Nomination forms will be located in

the Office Manager’s area.

3. Upon nomination, the employees’ Manager/Direct Supervisor must sign and complete

the Manager Screening Tool. All persons nominated for recognition may not, in fact,

be eligible. Keeping the process confidential will help to avoid hurting someone, and

bring credibility to the nomination process. Any staff member on a written

disciplinary action will not be eligible for nomination.

4. Any peer from the nominee’s department must submit written supportive

statements explaining why the nominee is deserving of the award. Specific

recognition should be noted, examples:

•

Attendance

•

Performance above and beyond

•

Patient satisfaction

•

Customer Service

5. The Recognition Review team will meet monthly to determine the winner. Initially

the review team will consist of three employees from Patient Coordination, then one

review member being replaced with the nomination winner. The review team will

consist of three employees at all times in determining a winner. In case of a tie,

department Director will make final decision.

6. Winners will be recognized each month and receive a certificate acknowledging

Employee of the Month. Winner will also receive a meal ticket and an essential link

key chain. All monthly winners will have their names displayed for that particular

month on a plaque displayed within the department. Quarterly, the entire

department will participate in a potluck in honor of the winners.

Sample Employee Of The Month Peer Nomination Form