Best Catch Award Nomination Form
The Best Catch Award is meant to enhance awareness of medication safety and facilitate prevention of medication errors.

We ask you to submit your or a colleague's “near miss” or medication error report story. The Best Catch story will be featured in the PostScript and the author will be awarded a $15 Tim Horton’s Coffee Card! Anonymity will be maintained at the submitting individuals’s request.

Contact Information
Nominee's Name *
Your answer
Nominee's Workplace (eg, Hospital or Health Region) *
Your answer
Nominee's Email Address or Phone Number *
Your answer
Your Name
Your Workplace (eg, Hospital or Health Region)
Your Email Address or Phone Number
Do you agree to be contacted if more information is required?
Would you like your submission to remain anonymous?
Description of the Catch
Please describe the story in 100-250 words. Successful submissions often contain information regarding: the location (eg, "I was on the unit"), current activity ("I was counselling a patient"), call to action ("when I overheard..."), investigative steps ("when I asked about..."), action taken ("I called the caregiver"), and negative consequences (potentially or actually) avoided by taking action ("the patient would have been taking 10x the regular dose and would be at risk of...").

IMPORTANT: Do NOT include any patient information, or information that could be traced back to the patient.

The Story
Your answer
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