OSFM Valor Award Nomination Form

Indicates required field

Nominee Information

Nominee's Full Name

Please provide the nominee's full name as it should appear on the award.

Fire Department/Agency Name

Nominee's Rank/Position

Nominee's Cell Phone

Nominee's Email Address

Nominator's Full Name

Relationship to Nominee

Nominator's Cell Phone

Nominator's Email Address

Date of Incident

Location of Incident

Description of Incident

Provide a detailed account of the circumstances, actions, and challenges faced by the nominee during the incident.

Demonstration of Valor

Explain how the nominee demonstrated exceptional courage, bravery, and quick thinking during the incident.

Positive Outcome

Describe the positive impact of the nominee's actions on the individuals involved, the community, and the fire department.

Risk and Sacrifice

Highlight any personal risks or sacrifices made by the nominee to ensure the safety and well-being of others.

Proposed Date and Time of Award Ceremony

Proposed Location of Award Ceremony

This nomination is a surprise. Please do not contact the nominee directly.