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© Australian Capital Territory, Canberra | health.act.gov.au Individual and team nominations will be accepted for this category 1. Initiates, undertakes and evaluates quality improvement or clinical research activities (maximum of 200 words). 2. Effectively leads and integrates knowledge and evidence into practice to improve patient outcomes (maximum of 200 words). 3. Consistently works in collaboration with individuals and teams to embrace evidence informed clinical practice environments (maximum of 200 words). 4. Models exemplary professional behaviour (maximum of 200 words). 5. Demonstrates outstanding professional commitment (maximum of 200 words). EXCELLENCE IN QUALITY IMPROVEMENT OR RESEARCH PRACTICE Nomination form template

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© Australian Capital Territory, Canberra | health.act.gov.au

Individual and team nominations will be accepted for this category

1. Initiates, undertakes and evaluates quality improvement or clinical research activities (maximum of 200 words).

2. Effectively leads and integrates knowledge and evidence into practice to improve patient outcomes (maximum of 200 words).

3. Consistently works in collaboration with individuals and teams to embrace evidence informed clinical practice environments (maximum of 200 words).

4. Models exemplary professional behaviour (maximum of 200 words).

5. Demonstrates outstanding professional commitment (maximum of 200 words).

6. Consistently demonstrates professional integrity (maximum of 200 words).

This template can be saved for copying to the online nomination form at health.act.gov.au/NMawards. Once your online nomination is submitted you will not be able to amend or add attachments.

EXCELLENCE IN QUALITY IMPROVEMENT OR RESEARCH PRACTICENomination form template