Moorfields' Stars staff nomination form Moorfields’ Stars is back for another year to celebrate staff achievements. Thank you for taking the time to recognise the great work colleagues across the trust are doing. Please complete the questionnaire below and don't forget to press 'done' when you're finished. OK Question Title * 1. Your name OK Question Title * 2. Your job title OK Question Title * 3. Your contact details (email or mobile number) OK Question Title * 4. Are you staff at: Moorfields UCL Institute of Ophthalmology Other OK Question Title * 5. We are asking for your contact details so that we can get in touch should we need additional information from you. Your contact details will not be used for any other purpose, shared without your express permission and will be deleted once the nomination process has been completed. If your nominee is shortlisted, we may contact you to ask if you would be happy to appear in a short video interview. Would you be willing to be filmed? Yes No OK Question Title * 6. Please tick the award that you are nominating an individual or team for: Moorfields’ star of the year award Moorfields' team of the year award Moorfields Eye Charity award for innovation and service improvement Moorfields’ volunteer of the year award Moorfields’ leadership award Moorfields’ unsung hero award OK Question Title * 7. Please complete the appropriate section below depending on whether you are nominating a team or an individual for an award. Individual nominee's name Individual nominee's job title Individual nominee's department Individual nominee's contact number Individual nominee's email address Team name Team leader's name Team leader's telephone number Team leader's email address Team's location OK Question Title * 8. What action did the nominee(s) take that has made you want to nominate them? OK Question Title * 9. When did the nominee(s) take this action? OK Question Title * 10. How does this action go above what’s involved in the nominee(s)’s daily role? OK Question Title * 11. How has this action positively impacted on our patients/colleagues/the trust? OK Question Title * 12. What evidence have you got to illustrate the positive impact this action has had?Where possible, use factual examples of improvements including patient feedback (statements/comments), clinical outcomes or financial reports. OK Question Title * 13. Which of The Moorfields Way values did the nominee(s) demonstrate? Caring Excellent Inclusive Organised OK Question Title * 14. Which of the Moorfields strategic objectives has the nominee(s) helped to deliver? We will pioneer patient-centred care with exceptional clinical outcomes and excellent patient experience. We will be at the leading edge of research, making new discoveries with our partners and patients. We will innovate by sharing our knowledge and developing tomorrow’s experts. We will collaborate to shape national policy. We will attract, retain and develop great people. We will have an infrastructure and culture that supports innovation. We will have a sustainable financial model. We will be enterprising to support and fund our ambitions. OK Question Title * 15. In no more than 300 words, please summarise your reasons for nominating this individual/team. OK DONE - THANK YOU FOR NOMINATING.