AAMI & Becton Dickinson's Patient Safety Award Application

This award recognizes outstanding achievements by healthcare professionals who have made a significant advancement toward the improvement of patient safety.

The prize consists of a plaque to be presented at the AAMI Exchange and a $1,500 check.

Note: Applicants are welcome to apply for this award in consecutive years, but must submit an original application each time.

Entries for the AAMI & Becton Dickinson's Patient Safety Award must include:

Nominator’s cover letter that provides a rationale statement describing the nominee’s advancement toward patient safety and the nominee’s involvement in supporting improvements to patient safety by participating in national, state or local patient safety organizations or programs.
This completed Patient Safety Award nomination form.
A current CV/Resume for the nominee
One or more letters of recommendation from the past year supporting this nomination from supervisors, colleagues, and industry partners.

* 1. Nominee Information

Nominee's Name:

Title:

Company/Affiliation:

Mailing Address:

Phone Number:

Email Address

2. Group Nominee Information

If the nomination is for a group/team, please attach the above information for each member of the group/team here.

*3. Nominator Information

Nominator's Name:

Title:

Company/Affiliation:

Mailing address:

Phone number:

Email Address

Email

Are you affiliated with the nominee? Note yes or no, and if so, describe your affiliation:

* 4. Award Criteria: Nominees must meet all of the following:

Nominee demonstrates that he/she is dedicated to improving the quality of healthcare and patient safety. Please describe:

Nominee is currently and directly involved with a specific safety initiative to improve the safety of clinical technology or its use in healthcare. Please describe:

Nominee has shown a commitment to patient safety by writing articles, participating in committees, and/or speaking at educational events on patient safety-related topics involving technology. Please describe:

5. Award Criteria: Nominees should meet the following:

Nominee has demonstrated leadership in advancing the quality of healthcare and patient safety in their organization. Please describe:

Nominee has been recognized by their employer for contributions to patient safety. Please describe:

6. Nominator Cover Letter

Upload nominator’s cover letter that provides a rationale statement describing the nominee’s advancement toward patient safety and the nominee’s involvement in supporting improvements to patient safety by participating in national, state or local patient safety organizations or programs.

7. CV/Resume

Upload a current CV/Resume for the nominee here.

8. Letter of Recommendation

Upload a letter of recommendation supporting this nomination from supervisors, colleagues, and industry partners here.

9. 2nd Letter of Recommendation

Upload an additional letter of recommendation supporting this nomination from supervisors, colleagues, and industry partners here.

10. Nominators are encouraged to submit examples and/or supporting documents that highlight additional activities relevant to this award.

Please upload any desired supporting documents here.