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Reward and Recognition Nomination Form

Reward and Recognition

The Employee and Volunteer Reward and Recognition program is designed to reinforce excellence and acknowledge the achievements and success of our employees and volunteers throughout Nepean Blue Mountains Local Health District.

The program is celebrated annually and nominations can be made at any time.


Nominations can be made for individuals or teams who go above and beyond the scope of their normal duties and responsibilities in making a measurable positive difference in one of the categories listed below.

The categories can be described as follows:

Customer Service

Commitment to high standard of customer service and demonstrates outstanding responsiveness to address customer concerns.

Improved Performance

Improving systems or processes - streamlining, cost saving, goals achieved in spite of significant obstacles, reduce or eliminate inequitable outcomes.

Leadership and Management

Good people management skills, proactive, provides leadership, manage issues and supports staff, effective communication and interpersonal skills.


Sharing responsibilities, displaying support for one another, overcoming difficulties together, cooperation, responsiveness and building team spirit.


Introduce initiatives that lead to greater efficiency in the workplace, quality of service/product/system improvement, statewide initiative and ideas generated.

Nomination Form

Please complete the form below by first selecting a category and then completing the nominee details.

Select one Category only* - required
Please select Nominee Type (either Individual OR Team) and complete the relevant details:

Individual Nominations

Team Nominations

Nomination Details

The information that you enter below will be used to assess the nominee/s achievements and success.

Please ensure you include appropriate and relevant information to assist the Reward and Recognition Review Committee evaluate this nomination against the programs guidelines and criteria.


Please provide details of why you are making this nomination.


Please provide a specific example of how your nominee/nominees have gone above and beyond the scope of their normal duties and responsibilities within your nominated category.


Please provide any additional information to support your nomination.

Nominator Information

Mandatory field(s) marked with *