Use this form to acknowledge an exemplary act performed by an SIU School of Medicine employee who you believe promotes, displays, and truly lives the SIU School of Medicine Behavior Standards.

Instructions

The Harbinger of Goodwill program was established to recognize SIU School of Medicine employees for going above and beyond the school's commitment to its behavior standards: collaboration and partnership; compassion and respect; integrity and accountability; diversity and inclusion; and continuous improvement. 

Any employee or patient who wishes to recognize the efforts of an employee can nominate an SIU Medicine team member. Nominations will be provided to the employee's supervisor along with a recognition lanyard that can be worn with your SIU School of Medicine ID Badge. His/Her nomination will also be celebrated in the employee newsletter as well as on SIU Medicine's intranet.

Download and complete the form to the best of your ability. If you have questions regarding the completion of this form, contact Human Resources at 217-545-2076.

Name: Enter the name of the nominee.

Department (Organization): From the drop-down list, select the name of the department where the appointee is employed.

Behaviors: The employee consistently meets the following behavior standards. Please check all that apply.

  • Collaboration and Partnership
  • Compassion and Respect
  • Integrity and Accountability
  • Diversity and Inclusion
  • Continuous Improvement

Event description: Provide a description of the situation involving the employee you are recognizing that clearly demonstrates he/she meets the criteria of the Harbinger of Goodwill award.

Name of nominator: The nominator should sign the form before submitting if sending hard copy. If submitting via e-mail, the name of the nominator should be entered.

Nominator’s department (organization): From the drop-down list, select the name of the department where the nominator is employed, if applicable.

Phone: Enter your phone in case we need to contact you for more information. 

Date nominated: Enter today's date.

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