Employee of the Month Nomination Form
The Employee of the Month Award highlights employees who pose a high-quality work performance, diligence, and dedication in carrying out their duties and advancing the mission of the Adams County Regional Medical Center. The Employee of the Month program is a twelve month initiative with monthly recognition. Awarded employees will be announced the first Thursday of each month.
Date of Submission:
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Month
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Day
Year
Date
Name of Nominee:
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First Name
Last Name
Position:
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Department:
Nomination Category:
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Please Select
Excellent Performance Record
Provides Outstanding Customer Service
Exhibits Innovative Problem Solving
Performed a Distinguished Deed
Enhances the image of ACRMC
Please provide specific, detailed examples to support your nomination. The information you provide will be used by the Employee of the Month committee to determine the recipient of this award:
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Name of Nominator:
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First Name
Last Name
Phone Number of Nominator:
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Please enter a valid phone number.
Please select one of the following that applies to your relationship with the Nominee:
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Please Select
Coworker
Supervisor
Patient
Community Member
Thank you for your nomination!
The employee that is selected to be the Employee of the Month will receive a photo displayed on the “Wall of Fame” located in the hospital’s lobby, a $100 gift certificate to a local business, a featured article on acrmc.com and social media post, a plaque and a n employee of the month service pin.
Submit
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