2019 Wildfire Emergency Medical Service Award Nomination

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

To nominate an individual for a National Wildfire Coordinating Group – Incident Emergency Medical
Subcommittee Wildfire Emergency Medical Service Award, complete this nomination form adding
supporting documentation (e.g., a description of the event, news articles, pictures, plus any other
associated documentation).

The completed form must be sent and received by December 31, 2019. Nominations must be addressed to The Wildfire EMS Awards Selection Committee at the address below. Each nominee will be notified of their nomination in writing by the IEMS and may withdraw his/her name from consideration at any time. The nomination committee will contact the nominees' Supervisors prior to award to ensure good standing with their agency/department/organization. An individual may not nominate him/herself.

NOTE: The nominator should make certain the nomination is for an act, accomplishment, or
endeavor that was truly above and beyond the nominee’s job duties or every day mission.

Email *

Nominated By *

Your Agency/Department

Your Contact Information: phone/physical address

The Following Individual(s)/Crew/Squad/Program/Service/Agency/Organization is nominated for: If nominating more than one individual for a category attach additional copies of this form for each person. *

Outstanding Wildfire EMS Individual of the Year Award - This award honors an EMR/EMT/AEMT or Paramedic who has demonstrated independent initiative in the areas of quality assurance, patient care, public access, medical control, disaster preparedness, public education and/or training, and has demonstrated support, involvement and dedication to their wildfire EMS community and wildland profession.

Outstanding Wildfire EMS Squad/Crew/Team of the Year Award - This award honors a wildland fire Squad/Crew/Team which has demonstrated independent initiative in the areas of quality assurance, patient care, public access, medical control, disaster preparedness, public education and/or training, and has demonstrated support, involvement and dedication to their wildfire EMS community and wildland profession.

Outstanding Wildfire EMS Distinguished Service Award - This award recognizes an organization, agency, corporation, institution, or individual who has provided unparalleled service in wildfire EMS, and in so doing, have greatly enhanced the visibility and awareness of wildfire EMS. This award is not necessarily awarded annually; it will be reserved for recognition only when such extraordinary and unusual circumstances so merit.

Award of Excellence in Wildfire EMS/Rescue - This award recognizes an individual(s) who has displayed an act of selflessness and heroism above and beyond the call of duty during a wildfire emergency medical, rescue incident or unexpected event. Eligible recipients include members from a NWCG member agency or from an agency/organization called to assist a NWCG wildland agency. This award is not necessarily awarded annually; and, multiple awards may be awarded in one year.

The Janette Peterson Lifetime Achievement in Wildfire EMS Award - This prestigious award may be presented to an individual who has demonstrated a long standing commitment to the advancement of and leadership in wildfire EMS. The Janette Peterson Lifetime Achievement in Wildfire EMS Award is not necessarily awarded annually.

Nominee’s Name/Position: *

Nominee’s Agency/Dept./Crew/Unit: *

Nominee’s Address: *

Nominee's Email/Phone *

Please explain why you believe this candidate is deserving of the award. *

Any other supporting attachments or documentation, please email them to nwcgiems@gmail.com. **Please indicate in the email which nomination the attachments support** Once submitted, all material becomes the property of the NWCG Incident Emergency Medical Subcommittee and will not be returned. Are you planning to submit additional information via email? *

Yes

Questions may be directed to: L. Kaili McCray, IEMS Subcommittee Chair, 208-387-5810, larry_mccray@ios.doi.gov The Wildfire EMS Award Winners will be announced end of June 2020.

Submit

Clear form

Never submit passwords through Google Forms.

This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy

Forms