Nomination Form
Name of Nominee
Department Name
Employee ID Number of Person Completing Nomination Form
Would you like to remain anonymous? (This means your name will not be included in the materials used to promote the Employee of the Month.)
No
Yes
Key Basic Ratings
Safety
5 - Exceptional
4 - Above Average
3 - Average
2 - Needs Improvement
1 - Poor
Courtesy
5 - Exceptional
4 - Above Average
3 - Average
2 - Needs Improvement
1 - Poor
Professionalism
5 - Exceptional
4 - Above Average
3 - Average
2 - Needs Improvement
1 - Poor
Efficiency
5 - Exceptional
4 - Above Average
3 - Average
2 - Needs Improvement
1 - Poor
Nomination Narrative