AVFRD Commendations and Citations Submission Form

When completing the justification for a specific award, please provide a detailed description of the incident. The justification should include, but not limited to the following information:

Summary paragraph of the specific act (what the person(s) did to deserve recognition)
Date of the act
Time of day of the act
Location of the act (street address)
Other participants in the act (name, rank, unit, etc.)
Persons given aid (age, sex, address, type of aid, hospitalization, diagnosis, outcome)
Injuries to nominee(s) (treatment, hospitalization, diagnosis)
Equipment used at scene
Equipment used by nominee(s)
What specific dangers existed
List specifically what the nominee did
Describe the area/scene (entry, path of rescue, hazards, point of rescue, weather, etc.)
Other recognition received by nominee

Accommodations and Citations

Name of Submitter:(Required)

First Last

Email of Submitter:

Nominee Name(s) or Unit:(Required)

Date of Incident:(Required)

Incident Number (if known)

Award Type:(Required)

Gold Medal of Valor Award

Silver Medal of Valor Award

Bronze Medal of Valor Award

Life Saving Award

Unit Citation Award

Distinguished Service Award

Appreciation/Citizens Award

Gold Medal of Valor Award Justification:(Required)

Gold Medal of Valor – Recognition of acts involving supreme sacrifice, extreme personal risk, and heroism, which is clearly above and beyond the call of duty.

Silver Medal of Valor Award Justification:(Required)

Silver Medal of Valor – Recognition of acts involving significant personal risk and bravery beyond what is expected during the performance of duty.

Bronze - Medal of Valor Award Justification:(Required)

Bronze Medal of Valor – Recognition of acts involving personal risk and demonstrating unusual judgment, zeal, and/or ingenuity during an emergency when such action is beyond that normally expected in the performance of duty.

Life-Saving Award Justification:(Required)

Life-Saving Award – For an act within the member’s scope of training and duty in actions involving either fire ground operations or emergency medical services that directly contribute to saving a life.

Unit Citation Award Justification:(Required)

Recognition of a single unit that performs in a superior manner on the scene of an emergency incident. The unit must display outstanding execution of duties and performance as to set it apart from other units with similar duties

Distinguished Service Award Justification:(Required)

Distinguished Service Award – Recognizes system member’s exemplary performance and service of either an operational or administrative nature who has increased their unit, division, or department efficiency or effectiveness. Nominee is any member(s) of AVFRD. This performance can occur during an emergency incident(s) or in a non-emergency function such as training, administration, education, prevention, or public and community service.

Appreciation/Citizens Award Justification:(Required)

Appreciation/Citizens Award – Awarded to an AVFRD member who performs an act worthy of recognition that reflects favorably on the department or to a civilian who renders outstanding service to AVFRD.

AVFRD Commendations and Citations Submission Form

Accommodations and Citations

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