Online Survey Software | Qualtrics Survey Solutions

Sunflower Support Staff Award

A Sunflower symbolizes warmth and happiness. The support staff works closely with the patient and has the opportunity to bring warmth and happiness demonstrating a caring and kind attitude. The Sunflower award is given to support staff that demonstrate exceptional teamwork that positively impacts the patient.

1. Please provide us with some information about yourself. If the Support Staff Member you nominate is chosen, we would like to include you in the celebration.

My Name

My Work unit, clinic, or floor

My Phone #

My Email

My Pager

I am a (RN, MD, Staff, Volunteer)

2. The Support Staff Member consistently meets all of the following criteria:

Demonstrates a caring attitude
Assists the nurse to meet the needs of patients and families
Consistently brings enthusiasm and energy to her/his daily work
Demonstrates role model behaviors

Ancillary Staff Member's name

Where the Ancillary Staff Member's (name of unit, clinic, or floor)

3. Anyone may thank a deserving Support Staff Member by filling out this form.

Please describe in detail this Support Staff Member's story.

Thank you for your time and commitment!

Once you click on "DONE" this nomination will be submitted for review. If you would like to nominate another Support Staff Member, please return to the link and open a new nomination form. You may nominate as many Support Staff Member as you would like.

Recipients will be honored at a special celebration held at their workplace during their shift.

If you have any questions, please contact:

Caitlin Heberer

caitlino@hs.uci.edu