4th Annual Public Safety Awards

NOMINATION FORM— Submission Deadline 4/24/20

Instructions: In order to properly evaluate this request, please complete this form (front and back) and provide

a detailed account of the incident/performance and why you believe it’s deserving of the award or acknowledgement, if

you feel necessary. Attach any paperwork related to the incident/performance that supports your request. Category

winners will be selected by the Washington County Chamber of Commerce Public Safety Awards Review Committee.

Return nomination forms to Donna Mitchell: donna@hagerstown.org

The award breakfast is scheduled for Thursday, June 11th, 2020

Submitted by: __________________________________________________________________________________

Dept.: ________________________________________________________________________________________

Nominee: _____________________________________________________________________________________

Dept.: ________________________________________________________________________________________

Current Assignment: ____________________________________________________________________________

Select the Category that Fits the Organization of the Nominee:

FIRE/RESCUE: Fire, EMS, DES

LAW ENFORCEMENT: MSP, HPD, Sheriff, Hancock, Boonsboro, Smithsburg.

CORRECTIONS: All three correctional facility locations.

PUBLIC HEALTH: ER, Health Department, Urgent Care.

INCLUDE WITH THIS APPLICATION

Detailed description of incident

Supervisor’s comments, if necessary

May submit additional documentation (i.e. photos, letters, etc.)

Supervisor’s Signature: ______________________________________________ Date: ____________________

UNIT ACHIEVEMENT AWARD (1 Winner from Each Category):

This honor is awarded to any bureau, division, section, unit, or squad exhibiting extraordinary performance,

attention to duty, and for an outstanding contribution to the department or to the welfare of our citizens.

PUBLIC SAFETY DISTINGUISHED SERVICE AWARD (1 Winner from Each Category):

This award is presented to a responder who is distinguished from all others of their rank or position. He or she

performs above expectation, demonstrates responsibility, and initiated a credible accomplishment in the previous year.

COMMUNITY SERVICE AWARD (Only 1 Person or Group is Able to Receive This Award Regardless of Category):

This award is presented to an individual, group or organization who has worked to better the lives of those in

Washington County, either inside or outside of normal job duties, or has performed a single outstanding

community service activity. Examples include: Education, mass education courses, crime reduction, self-defense, prevention.

Programs like “Coats for Kids”, etc.

LIFETIME ACHIEVEMENT AWARD (Only 1 Person of Group is Able to Receive This Award Regardless of Category):

The individual awarded this honor encompasses leadership and an exceptional work ethic. He or she has

consistently performed above & beyond normal expectation throughout their career.

MEDAL(s) OF VALOR AWARD

Gold: This award recognizes an act of bravery involving extreme personal risk that is clearly above and beyond the call of

duty or an incident of valor that results in serious injury or death.

Silver: This award recognizes acts of bravery involving great personal risk beyond the call of duty.

Bronze: This award recognizes acts of bravery involving unusual personal risk beyond expectation while performing

the usual responsibility. Bronze-level recognition may also be awarded to a member who demonstrates unusual judgement,

zeal, or ingenuity during an emergency situation when such an act is beyond that normally expected in the line of duty.

TELECOMMUNICATION AWARD (Telecommunications Category Only):

This individual, through their outstanding dedication and service has demonstrated an exceptional contribution to the improved

delivery of emergency medical, fire and law enforcement services to the citizens and visitors of Washington County.

VOLUNTEER ACHIEVEMENT AWARD (1 Winner from Each Category):

This honor is presented for volunteer dedication and initiative above and beyond the call of duty over a period of time that has

affected and benefited the citizens of Washington County and beyond.

GOOD SAMARITAN AWARD:

This award recognizes a non-uniformed, untrained citizen who clearly goes above and beyond, performing an act of selfless-

ness and bravery during an emergency situation.

HERO AWARD:

This award honors an individual or team whose actions attempted to save or succeeded in saving a human life. Recipients

demonstrate strong knowledge of medical and rescue efforts, quick action, and a commitment to service on and off duty.

Description of Awards

Please Select the Award You’re Submitting for: