NOMINATION FORMPerioperative Nurses Choice Award – Operating Room

Please complete ALL sections of the nomination form.

Nomination forms must be submitted on or before Thursday 24 March 2016

Completed nominations should be emailed to NurseMidwifeAwards@adhb.govt.nz

NOMINEE DETAILS (Their details)

Full name:

Current role:

Service area:

Email address:

NOMINATOR DETAILS (Your details)

Full name:

Service area:

Contact phone number:

Tell us ‘Which nurse would you most like to have in your theatre if you were the patient and why? (Maximum word count 350)