PEMS Regional EMS Award for Outstanding EMS Agency Nomination Form


Criteria for this award:  An EMS agency that exemplifies outstanding professionalism and service to its community; whose high level of patient care is evident by innovative training, community awareness, preventive health programs, public relations efforts and participation in local, regional and statewide EMS systems.

Eligibility for this award:  Any currently licensed or official agency that is recognized by the state or federal government that is based in Virginia and is directly responsible for responding to emergencies or disasters and providing the direct delivery of care.  Includes governmental, commercial, volunteer, hospital, industrial and air ambulance services.

Nominee Agency or Organization:*
Agency Phone:*
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Address of Nominee:*
Submitter Information
Submitted by:*
Submitter E-mail:*
Submitter Phone:*
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Brief Abstract of Nominee:
How does this EMS agency exemplify outstanding professionalism and service to their community?*
How does this EMS agency support their providers?*
Describe this EMS agency's enhanced programs, which provide a high level of patient care that is evident through innovative training, community awareness, preventive health programs, public relations efforts and participation in local, regional and state EMS systems.*
Supporting Documents:
Upload High Resolution Photographs of Nominee:
Letters of Recommendation:
Information Sheet Describing Agency and Response Area:
Other supporting documents (newspaper/periodical articles, press releases, etc.)
Ready to submit?

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