We recommend that you use the latest version of ChromeFirefox, or Safari when using the forms on the WHS website. If you are having issues with this form, please click here and download the latest version of Chrome on your computer.

Contact Information

Last Name
Field is required!
First Name
Field is required!
Phone
Field is required!
Contact Email
Field is required!
Re-Enter Email
Field is required!
Department
Field is required!

Project Information

Project Name
Field is required!
Team Member
Click the Plus + for additional team members
Field is required!
Department
Click the Plus + for additional department that will be involved
Field is required!
WHS Pillar of Focus
Check all that apply
Field is required!

Project Description

Brief Description of your Idea
Field is required!
What is the opportunity for improvement?
Field is required!
What is your plan of action?
Field is required!
File Upload
Upload diagrams, charts or scribbles to support your Plan of Action. Max file size 5mb. Jpg, Gif, PDF supported.
Upload your documents...
Field is required!
What is the impact?
Field is required!
File Upload
Upload diagrams, charts or scribbles to support your Impact. Max file size 5mb. Jpg, Gif, PDF supported.
Upload your documents...
Field is required!
What is your inspiration for the project?
Field is required!
How will success be measured? What are the expected outcomes?
Field is required!

Which health system team member(s) or department(s) will be able to help you?

Include all department that you think will need to be involved. Put a short description next to each department that you include. Click the Plus + if selecting more than one Department.
Department
  • - Select an Option -
  • Finance
  • Foundation
  • Housekeeping
  • HR
  • Information Systems
  • Maintenance
  • Marketing
  • Medical Staff
  • Nursing
  • Performance Improvement
  • PFCC
  • Police / Security
  • Population Health
  • Transport
  • Quality or Risk
  • Other
- Select an Option -
Field is required!
Short Description of Project Involvement
Field is required!
Which health system team members or departments will be able to help you?
Include the team members name from each department. Check all that apply.
Field is required!