Go Beyond

Go-Beyond Award
Nomination Form

The Go-Beyond program seeks to recognize staff who perform acts of kindness that are above and beyond the normal job duties/expectations and exceed the SH Service Excellence Expectations. Those who are eligible for nomination include employees, volunteers, students and physicians. When submitting a Go-Beyond nomination, please use your best judgment as to whether the nominee is truly going "above and beyond" their normal job duties. An example of a Go-Beyond moment: "John was talking to a patient who was very sad about being in the hospital. After work, he went out and bought the woman a rose and came back to give it to her."

All nominations are subject to review by the Employee Advisory Council and may not be awarded if they do not meet the intent of the Go-Beyond program

.
I nominate the following Employee/Volunteer/Physician/Group for their "Go-Beyond" moment.

First Name:
Last Name:


Department:


Campus:


Go-Beyond Date:
I am nominating this person or group because he/she contributed to
Susquehanna Health System's "Go-Beyond" Award Program
in the following way (Please be specific and detailed.)

Please be HIPAA compliant. Do not include any identifying patient information.


Your First Name:
Your Last Name:


Are You a(n)  Employee   Patient    Visitor   

If you are an Employee, what Department?