Oregon Fire Service Meritorious Awards Banquet
Nomination Form/ Authorization
Nomination Deadline: April 1, 2011
NOMINEE INFORMATION  
  First Name
*
  Last Name
*
  Agency
*
  Title/ Rank *
  Address
*
  City
*
  State
*
  Zip Code
*
  Phone Number
*
  Fax Number
 
  Email Address
*
   
NOMINATOR INFORMATION  
  First Name
*
  Last Name
*
  Agency
*
  Title/ Rank *
  Address
*
  City
*
  State
*
  Zip Code
*
  Phone Number
*
  Fax Number
 
  Email Address
*
   
EVENT INFORMATION (if being nominated for a specific event)  
  Date of Event
Except for Public Service, Awards of Excellence or Lifetime Achievement, a qualifying event must have occured between January 1, 2010 and March 31, 2011
  Location of Event
 
  Type of Event
 
  Did the Nominee act alone in the event? Yes
No		  
 
  Does the Nominee know that they are being nominated for this award?
Yes
No
By submitting this nomination form I certify that the information contained within is true and accurate to the best of my knowledge.
  Nominator's Name
 
  Date
 
All nominations must be authorized by the Agency's Fire Chief prior to submission. If the Fire Chief is the nominee, the Board Chairman or City Manager may sign and authorize the submission.
  Fire Chief's signature
 
  Date
 
   
OFCA - NOMINATION FORM/ AWARDS CRITERIA
 
MEDAL OF HONOR  
The Medal of Honor may be awarded to an individual who, intelligently and in the line of duty, gives his/her life or distinguishes him/herself by an act of extreme courage involving the risk of imminent danger to his/her life, with knowledge of such risk, above and beyond the call of duty. The aforementioned act must have been performed for the purpose of saving or protecting human life.
  
Please be sure your nominee has met the following criteria:  
  • The nominee has shown extreme courage in the line of duty.
  • The nominee has placed themselves in imminent danger to his/her life or lost his/her life.
  • The nominee has gone above and beyond the call of duty.
  • The nominee was performing the act to save or protect a human life.
 My nominee has met all of the above criteria.
The selection committee will evaluate your submission based solely on your description submitted on the last page of this nomination packet. It is very important to be expressive and descriptive in explaining the event. Explain in detail the courage shown, dangers faced and the risk to the nominee's life.
     
MEDAL OF VALOR  
The Medal of Valor may be awarded to an individual who, intelligently and in the line of duty,distinguishes him/herself in the performance of an act of courage involving risk of imminent serious physical injury, with knowledge of such risk, for the purpose of saving or protecting human life. Or, in thecourse of an extended investigation of a nature where he/she is continuously and singly exposed to grave personal hazard, willingly accepts such risk.
  
Please be sure your nominee has met the following criteria:  
  • The nominee has acted in the line of duty.
  • The nominee acted with courage while knowingly risking serious physical injury.
  • The nominee was acting to save and/or protect a human life.
 My nominee has met all of the above criteria.
The selection committee will evaluate your submission based solely on your description submitted on the last page of this nomination packet. It is very important to be expressive and descriptive in explaining the event. Explain in detail the courage shown, dangers faced and willingness to act.
     
AWARD OF EXCELLENCE  
The Award of Excellence may be presented to any individual who performs one or more of the following:
  1. An act of intelligence and valuable service, demonstrating special faithfulness or perseverance.
  2. Highly credible acts of fire service over an extended period of time.
  3. Continuous professionalism, as indicated by superiors and performance evaluations, or who has, in a specific instance, performed his/her duties in a particularly admirable manner.
  4. Developed a program, process or equipment that positively affects the Fire Service.
  5. Currently serves as the President or Chairperson of an Oregon-based fire-related Association, that is recognized by the Oregon Fire Service.
 My nominee has met all of the above criteria.		  
The selection committee will evaluate your submission based solely on your description submitted on the last page of this nomination packet. It is very important to be expressive and very descriptive in detailing the nominee's dedication to the fire service. Include a description of any programs, processes or equipment developed and its effect on the fire service.
     
DISTINGUISHED CONDUCT  
The Distinguished Conduct Award may be awarded to any member of the fire service who has acted with professionalism and efficiency when faced with a specific danger or adversity and who has carried out his/her duties properly despite this danger/adversity. The action for which this award is given shall be considered exceptional by other emergency responders.
  
Please be sure your nominee has met the following criteria:  
  • The nominee is a member of the fire service.
  • The nominee has faced specific danger or adversity.
  • The nominee acted with professionalism and efficiency.
  • The nominee's duties were carried out properly despite the danger and adversity.
  • Other emergency responders would consider the nominees actions exceptional.
 My nominee has met all of the above criteria.
The selection committee will base their decision on your description submitted on the last page of this nomination packet. It is important to be expressive and very descriptive in recounting the event. Explain in detail the professionalism shown, dangers or adversity faced and the willingness to act. Express why other emergency responders would consider this an exceptional act.
     
UNIT CITATION  
The Unit Citation may be given to two or more individuals, functioning as a group, who have worked together towards a common goal. The citation may be awarded for a specific performance of exceptional quality or for continued, professional performance and dedication to duty by the unit as a whole.
  
Please be sure your nominee has met the following criteria:  
  • The nominees must have functioned as a group towards a common goal.
  • The performance of the group must be exceptional quality or continued professional performance and dedication to duty.
 My nominee has met all of the above criteria.
The selection committee will base their decision on your description submitted on the last page of this nomination packet. It is important to be expressive and very descriptive in recounting the groups performance. Explain in detail the professionalism shown, and/or dedication to duty by the unit.
     
CITIZEN LIFE SAVING  
A citizen’s award is to recognize citizens, businesses, and other groups for efforts that result in saving another's life, benefiting the Fire Service, or other honorary action.
  
Please be sure your nominee has met the following criteria:  
  • The nominee is not associated with the fire service.
  • The nominees actions resulted in saving another's life, benefiting the fire service, or other honorary action.
 My nominee has met all of the above criteria.
The selection committee will base their decision solely on your description of the events submitted on the last page of this nomination packet. It is very important to be expressive and descriptive in explaining the nominee's efforts and actions.
     
PUBLIC SERVICE AWARD  
The Public Service Award may be awarded to an individual or group who has unselfishly given to the fireservice, above and beyond expected performance. This individual or group will have shown distinguished public service, promoting fire and life safety in the state of Oregon.
  
Please be sure your nominee has met the following criteria:  
  • The nominee/nominees have unselfishly given to the fire service.
  • The nominee/nominees have performed above and beyond the expected level of performance.
  • The nominee/nominees have shown distinguished public service promoting fire and life safety in the State of Oregon.
 My nominee has met all of the above criteria.
The selection committee will evaluate the nominee/nominees based on your description of their commitment to the Oregon Fire Service. Use examples of the nominee's dedication and professionalism in promoting fire and life safety. Please include any sacrifices and challenges faced on the submission page of this nomination packet.
     
LIFETIME ACHIEVEMENT AWARD  
This award shall be considered to be the "Hall of Fame" award of the fire service. The Lifetime Achievement Award may be given to a nominee who has distinguished his, her or themselves with a lifetime of exemplary public fire service. The recipient of this award will have contributed no less than 10 years of service promoting fire and life safety; the accomplishments should reach beyond the department and should be universally known to the fire service. This award may be given to one nominee annually. The nominee(s) shall remain on a 5-year limited perpetual list for possible reconsideration.
  
Please be sure your nominee has met the following criteria:  
  • The nominee has dedicated no less than 10 years to the public fire service.
  • The nominee has distinguished his/her self from others.
 My nominee has met all of the above criteria.
The selection committee will consider the nominee based upon your portrayal of their achievements and accomplishments in the fire service. Be descriptive on the submission page of this nomination packet and explain why this particular person deserves this award.
     
PLEASE NOTE: The selection committee reserves the right to consider the nominee for an award other than that which is submitted.
     
OFCA - NOMINATION FORM
     
Please type the description for the qualifying event.
       
 
 
Thank you for your nomination submission!