Advancing Safe Care Award Nomination Form

Nominee Information

Name of Nominated MHA-Member Organization(Required)

Name of Project(Required)

Name of Key Contact Person for Project(Required)

First Last

Job Title(Required)

Address(Required)

Street Address Address Line 2 City State ZIP Code

Phone(Required)

Fax

Email(Required)

Names of Team Members(Required)

Project Aim(Required)

Most Significant Outcome(Required)

Submitter Information

Name(Required)

First Last

Title(Required)

Organization(Required)

Address(Required)

Street Address Address Line 2 City State ZIP Code

Phone(Required)

Fax

Email(Required)

Narratives

*Answer in 500 words or less

Improved Safety Outcomes Among High-Risk Populations (25 points)(Required)

The data demonstrates that certain employee groups, roles, locations or situations face a higher risk of workplace violence.
· Demonstrate how data was used to identify high-risk areas, roles or populations (e.g., frontline staff, night shifts, customer-facing teams).
· Show how targeted interventions were implemented to reduce risk and improve safety outcomes.
· Provide evidence of measurable improvements (e.g., reduction in incidents, near-miss reporting, response times or staff perception of safety).

Culture of Continuous Learning & Violence Prevention (25 points)(Required)

Preventing workplace violence requires continuous learning, system-wide improvement and shared accountability.
· Show how the organization has strengthened its approach to violence prevention through ongoing learning and improvement practices.
· Demonstrate how training, simulations or incident reviews have evolved to improve preparedness and response.
· Highlight how feedback loops — from frontline staff to leadership — inform and improve safety strategies over time.

Transparency & Communication Around Safety (25 points)(Required)

Transparency is critical to building trust and ensuring proactive prevention of workplace violence.
· Demonstrate how safety information, incidents and prevention strategies are openly communicated within the organization (e.g., safety huddles, dashboards, alerts, newsletters).
· Show how communication supports awareness of risks, reporting expectations and shared accountability.
· Provide examples of communication and partnership with external stakeholders (e.g., security, law enforcement, community partners) when appropriate.

Advancing Psychological & Physical Safety Culture (25 points)

A strong safety culture ensures employees feel both physically protected and psychologically safe to speak up.
· Provide evidence of efforts to create an environment where staff feel safe reporting concerns, threats or incidents without fear of retaliation.
· Demonstrate leadership commitment to violence prevention through policies, visibility and reinforcement of safe behaviors.
· Highlight initiatives that support both physical protections (e.g., security measures, protocols) and psychological safety (e.g., support after incidents, debriefs, employee resources).

NOMINATIONS MUST BE RECEIVED TO THE MHA BY THE CLOSE OF BUSINESS FRIDAY, AUGUST 14, 2026.

Supplemental materials, such as charts, data, etc., can be sent to eleyko@mha.org, but will be limited to two documents.

Note: Forms will not be accepted if they include URLs.