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Category 2: Engaging with consumers, carers and the community The projectName of project
……………………………………………………………………………………..
Is this project a joint submission with an organisation or organisations external to WA Health?
Yes………….
No…………...
Name of nominee
Please note: only projects or teams (not individuals) can be nominated for the project awards.
Primary contact in WA Health
Name……………………………………………………………………………………
Title……………………………………………………………………………………..
Employing entity (Please give full details - health service, division, directorate, unit/branch, etc.)
………………………………………………………………………………………….
Address………………………………………………………………………………...
Telephone……………………………………………………………………………..
Primary contact email address……………………………………………………...
External partner organisation(s) contact details
If this project is a joint submission with an organisation or organisations external to WA Health, the lead organisation will be considered to be WA Health. Please list the other organisation(s) below.
Organisation name…………………………………………………………………..
Contact person……………………………………………………………………….
Title……………………………………………………………………………………..
Telephone………………………………………………………………………………
Email address………………………………………………………………………….
Organisation name…………………………………………………………………..
Contact person……………………………………………………………………….
Title……………………………………………………………………………………..
Telephone………………………………………………………………………………
Email address………………………………………………………………………….
Organisation name…………………………………………………………………..
Contact person……………………………………………………………………….
Title……………………………………………………………………………………..
Telephone………………………………………………………………………………
Email address………………………………………………………………………….
Sign off (Tier 2 or above)
Name:…………………………………………………………………………………….
Organisation:……………………………………………………………………………
Date:………………………………………………………………………………………
250 word summaryPlease provide a brief overview of the project for promotional purposes. You might follow the SAO format – situation, action, outcome, to tell the story of your project in a succinct format.
This does not form part of judging, but is needed to give judges context for application and will be used in all promotional materials.
General questionsIn a maximum of four (4) pages please address the following criteria.
Note: each nomination form will begin with the question that relates to the category.
1. Engaging with consumers, carers and the community (10 points)
Describe the situation or problem that initiated this project and how this has achieved better health care outcomes through engagement activities with consumers, carers and/or the community.
2. Research and consultation (20 points)
Describe the research and/or consultation undertaken before developing and implementing the project.
3. KPIs and objectives (10 points)
What KPIs, targets or objectives were set for the project?
4. Implementation (30 points)
Describe the implementation process – including approvals, timelines, resources used, budget, change management and challenges faced.
5. Monitoring and evaluation (30 points)
How was the project monitored and evaluated against objectives, and what were the findings and lessons learnt and how were they measured against KPIs.
Explain in your response how the evaluation has changed work practices, resource allocation or processes and if the project is ongoing?
How to submit your nominationDeadline for submissions: Friday 20 July 2018
Once you have completed your nomination form, please email it to:
A confirmation receipt will be emailed to the primary WA Health contact.
More information:
Event Manager Communications Directorate Department of HealthPO Box 8172Perth Business Centre WA 6849
189 Royal Street, East Perth 6004
Phone: 9222 6425
Email: [email protected]
