Delaware State
Fire Prevention Commission

Firefighter/EMT of the Year Nomination Form

Important Note:

The Firefighter of the Year nomination deadline is October 1st of each year.

The EMT of the Year nomination deadline is May 1st of each year.

Name of Fire Dept/ EMS Provider/EMS Company

Name of Supervisor/Fire Chief/President filling out this form

Your email

Today's Date

Date of Incident

Time/Location

Nominee (Who are you nominating for this award?):

Years of Service

Volunteer/Career

Location (Where were you & the nominee when the event being recognized occurred.):

List of Witnesses that witnessed the 'event':

Briefly describe the incident(s) that merit the nomination of the above candidate

How has this person shown excellence above and beyond what is expected during this incident?

What personal traits, skills, or qualities did this person exhibit during this incident?

What accomplishments and strengths impress you most about this person during this incident?