GERRY HAYNES MEMORIAL AWARD
for Excellence in Infection Prevention & Control

ELIGIBILITY
Any individual who is a member of TSICP practicing in infection prevention and control.

GUIDELINES FOR SUBMISSION OF NOMINEE
The recipient IS recognized for accomplishments that exceed the job description of an Infection Control Preventionist. Preference is given to candidates whose contributions enhance infection control and prevention practices statewide.
Describe these contributions in details in the application

Nominee

First Name

Last Name

Nominee's Title

Nominee's Place of Employment

Nominee's Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Nominee's Email

Nominee's Preferred Phone

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Education (Degrees, Certifications, Infection Control Preparation

Infection Control & Prevention Experience

Affiliations with Professional Organizations

Community Service Activities

DETAILED ACCOUNT OF OUTSTANDING ACCOMPLISHMENTS: (i.e. . innovative project, professional contribution to the field of infection control, improvements on infection control practices in Texas, etc.) This information should be concise, but specific enough to demonstrate excellence in practice.

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