Gallantry nomination form examples
Gilt Cross
Name: Steve Fleur de Lis
1. Reason for the award nomination
Outline the incident or condition that’s been brought to your attention. Please be as specific as possible about dates and include as much detail as possible to help the National Awards Advisory Group understand the situation.
A group of adults were part-way through a white-water kayaking trip on Saturday 12 October, when one of the party became stuck and was becoming increasingly distress.
Steve Fleur de Lis played a valuable part in the rescue, providing reassurance, quick thinking and skill with little emphasis on himself.
2. Involvement in Scouts
Outline what the nominee does in/for Scouts and their usual character.
Steve is a Scout Network member and Cubs Section Team Leader. Steve is an enthusiastic leader who is has a calm and friendly manner in his approach to activities.
3. Key achievements and outcome
What has the nominee achieved (for themselves or others) by dealing with the incident or despite their condition?
Steve continues to have a very modest view of his contribution in this rescue. However, without his calm approach and understanding of the situation, the rescue may not have been as successful as it was. Steve however has been willing to share his thought process and recollection of the incident with others in his local Network, by doing this, his Network nominated him for a Royal Life Saving Award from Royal Life Saving Society UK.
4. Personal challenges
Think about the main challenges or risks that the nominee has had to overcome. For acts of bravery did they put their life at risk, and if so, how? If undergoing treatment for a medical condition, how has this affected them and what is the long-term prognosis?
Steve remained focused upon the causality throughout the incident, confident in his abilities and understanding of the situation. His personal fitness and well drilled approach to everything he does, played a big part in his being able to put aside his personal safety to ensure he focused on supporting the member of the group who was in distress.
5. Other community recognition
Outline any other recognition the nominee has received relating to the incident or condition described above. Examples could include: recognition from the emergency services or other organisations. Please also list the name and dates of any related awards received by the nominee.
The local Community Paper ‘The Star’ ran an article on the rescue and the Lord Mayor has visited one of the Network meetings to congratulate Steve and John on their actions. (Copy of local paper article attached).
6. Witness statements/evidence
Detail all external support for this nomination. Examples could include: statements from eye-witnesses, the emergency services, doctors or medical specialists or newspaper cuttings etc.
The following account is written by the man whose life was undoubtedly saved by the quick thinking and rapid response of the nominee:
On the day of the incident, we were part-way through a white water kayaking trip and had headed to a dam release river. The river was releasing on three pipes, providing sufficient white water for a continuous trip down to the bridge above the falls. We paddled down the river to an eddy above the final gorge and stopped to inspect it.
Steve ran the first section of the gorge while John and I kept an eye on him from the bank. Steve then pulled in to an eddy to protect it for us to run it. I set off first and Steve was close behind. As I left the eddy my attention was focused on the gorge; the lead up to it was fairly easy water, or so I thought! As soon as I left the eddy, the current started pushing me off course and up against the trees, which were partially underwater. I did not react quickly enough and became pinned against a tree. The pressure of the water was so great that I was trapped, unable to move at all.
Steve spotted what had happened and waded out through the current in chest-high water to try and help. Although I tried to offer what little assistance I could, Steve was unable to move my kayak. The water was surging and my head was either completely underwater or just far enough above the surface to allow me to breathe a mixture of water and air. Steve tried so hard to move the kayak and even managed to attach a line, but before he could pull on it, the water started surging even more and he had to come back to help me keep my head above water. Steve shouted to John for help and somehow his voice was heard above the deafening noise of the water.
Throughout the whole ordeal, Steve was shouting reassurance, telling me that I mustn’t give up and that they would get me out. John ran up the bank and saw what was happening, returning quickly to his kayak and paddling it through the current to help us. I was now feeling quite weak from oxygen deprivation and the crushing pressure of the kayak on my body. Whilst I didn’t ever totally give up, I was becoming convinced that the pressure was just too great to overcome and that I wasn’t going to get out. When John reached us, he took over the task of keeping my head above water. The two of them tried to shift the kayak, but to no avail.
Steve then set up a pulley system from a nearby tree and was able to move the kayak very slightly. I didn’t think it was going to be enough, but to my amazement, I was pulled from my buoyancy jacket and through the gap they had created between the kayak and the tree. Steve had to maintain the pull on the line throughout, which was no mean feat, considering it took three of us to shift the kayak afterwards. Together they then managed to get me across the current to the safety of the bank. After an emotional period of recovery, we set up a line with a 3:1 mechanical advantage. Despite this, it still took all three of us to pull the kayak out.
I am extremely grateful that John and Steve were well equipped with slings, ropes, karabiners and so on, but also that they were calm enough to deal with the emergency whilst putting their own lives at considerable risk.
Silver Cross
Name: Adam Hut
1. Reason for the award nomination
Outline the incident or condition that’s been brought to your attention. Please be as specific as possible about dates and include as much detail as possible to help the National Awards Advisory Group understand the situation.
During the evening of Saturday 15 June, the New Beach surf club launched their yacht for the purpose of a training exercise. The yacht was launched at 1800hrs, and the exercise was intended to last for two to three hours. The helmsman had a crew of two.
At approximately 2000hrs they picked up a radio message. Local coastguards were calling for auxiliary coastguards as it was reported that people were trapped on the rocks at the Cove. Adam, one of the yacht’s crew, radioed the local coastguard and told him who they were, offering to assist if required. The coastguard welcomed this offer and gave the location and further details; they also said that they were preparing to launch the local lifeboat.
Having received information regarding the exact location of the emergency, they made their way to the Cove and on arrival, were informed that two people were stranded. Fifteen minutes after arrival, details of the rescue plan came over the radio. Initially the coastguard requested the yacht crew to stay with the people once the lifeboat had rescued them from the rocks.
The lifeboat was launched from the shore as a large set of waves came through. After the waves had passed, the lifeboat made its exit out to sea, at a point about thirty metres from the rocks.
Adam swam out to the rocks and made his way to the stranded people. He made contact and assessed their condition. Confirming that they did not require medical attention, he shouted to the local lifeboat to pick them up. However, as the lifeboat came for them, the bow of the boat hit the rocks, slewing it sideways. This turned the lifeboat onto oncoming waves and capsized it.
As soon as the lifeboat capsized Adam immediately told the casualties to move back on the rocks to a safer position. As the coastguard prepared to launch a second lifeboat Adam realised that he would have to complete the difficult rescue himself.
Meanwhile, the surf club yacht had towed the capsized lifeboat and its crew out to sea, beyond the surf zone to a place of safety. When this task was completed, the yacht returned to the scene of the incident. Adam informed the second lifeboat crew that he intended to lower himself and the stranded people into the water one by one, swimming the thirty metres to the yacht. Successfully completing the swim with the first person, Adam was asked if he was happy to carry out the second rescue and he duly agreed.
Once the casualties were on board, they were transferred to the lifeboat and winched to safety by helicopter. His actions in rescuing both people from the rocks, with great risk to his own safety, were both heroic and truly exceptional.
2. Involvement in Scouts
Outline what the nominee does in/for Scouts and their usual character.
Adam is an Explorers Section Team Leader and support his county with their Regatta. He is a Master Yachts man and holds the County Learning Assessor accreditation for powerboats. Adam’s Explorer section benefit greatly from his years of seamanship.
3. Key achievements and outcome
What has the nominee achieved (for themselves or others) by dealing with the incident or despite their condition?
Adam helped save the lives of two people who were trapped on the rocks due to the incoming tide.
4. Personal challenges
Think about the main challenges or risks that the nominee has had to overcome. For acts of bravery did they put their life at risk, and if so, how? If undergoing treatment for a medical condition, how has this affected them and what is the long-term prognosis?
Adam, put his life at risk swimming to the rocks and then rescuing the two people trapped, the weather was fair that evening, but the outcome could have been very different without Adam’s support and knowledge.
5. Other community recognition
Outline any other recognition the nominee has received relating to the incident or condition described above. Examples could include: recognition from the emergency services or other organisations. Please also list the name and dates of any related awards received by the nominee.
Adam has received a letter of thanks from the Coastguard and was featured in the local paper. He sees his role as just doing what was necessary and would never class himself as a hero, although the action he took saved lives.
6. Witness statements/evidence
Detail all external support for this nomination. Examples could include: statements from eye-witnesses, the emergency services, doctors or medical specialists or newspaper cuttings etc.
Attached – letter from the two people rescued.
Attached – the Newspaper cutting and letter from the Coastguard.
Silver Cross
Name: Gale Explore
1. Reason for the award nomination
Outline the incident or condition that’s been brought to your attention. Please be as specific as possible about dates and include as much detail as possible to help the National Awards Advisory Group understand the situation.
I wish to nominate Gale for her actions on the morning of 29 October, which prevented a major catastrophe. The Bedford train line into London is a very busy commuter route, one of the busiest in the country. Even after the morning rush and particularly in the school holidays, families congregate on the platforms awaiting their trains. On this particular morning, a young boy (toddler, about three years old) had stepped away from his mother and was refusing to step back. When the mother stepped forwards, the boy did also, causing him to fall off the front of the platform and down onto the train line. He appeared to hit his head on the rail and lay in the middle of the track.
By standers were taken aback, but Gale was quick off the mark, dropped her rucksack and immediately jumped down onto the train line. A quick check revealed no trains approaching at that moment, which might require taking refuge under the platform and so she grabbed the boy and swung him back up onto the platform. He was retrieved by his family and given first aid. Gale found herself still on the track and unable to lift herself back onto the platform, due to its height. Thankfully another passenger stepped forward and offered his hand to give Gale a pull onto the platform, which she then did with ease.
All of this happened within a couple of minutes and thankfully resolved well for all. The toddler had a dislocated shoulder and a significant contusion to his head, but will hopefully recover well. Gale took this all in her stride and proceeded to take the next train into London and carry on with her day.
2. Involvement in Scouts
Outline what the nominee does in/for Scouts and their usual character.
Gale is an excellent Cubs Section Team Leader. She runs a popular and busy Pack and her number have grown steadily since she took over as Cubs Section Team Leader. Her sections programmes are excellent with lots of outdoor activities. She has quite a waiting list and we may have to think about opening another Pack to cope. This is down to Gale's success.
3. Key achievements and outcome
What has the nominee achieved (for themselves or others) by dealing with the incident or despite their condition?
Gale clearly saved this toddler's life.
4. Personal challenges
Think about the main challenges or risks that the nominee has had to overcome. For acts of bravery did they put their life at risk, and if so, how? If undergoing treatment for a medical condition, how has this affected them and what is the long-term prognosis?
Gale clearly put her own life in considerable danger in saving this toddler's life.
5. Other community recognition
Outline any other recognition the nominee has received relating to the incident or condition described above. Examples could include: recognition from the emergency services or other organisations. Please also list the name and dates of any related awards received by the nominee.
None.
6. Witness statements/evidence
Detail all external support for this nomination. Examples could include: statements from eye-witnesses, the emergency services, doctors or medical specialists or newspaper cuttings etc.
Dear District Lead Volunteer,
I would like to put on record my sincere gratitude for the prompt action of one of your leaders Gale. In short, she saved my three year old son's life by jumping onto a railway track when he fell off the platform and bumped his head. She then needed help to get back on to the platform before heading to work and my son being taken to hospital where he was found to have dislocated his shoulder and bumped his head. Words cannot express how thankful I was for her actions, putting herself in considerable danger.
Yours sincerely,
Mrs Marjory Bond
Bronze Cross
Name: Keith Jamboree
1. Reason for the award nomination
Outline the incident or condition that’s been brought to your attention. Please be as specific as possible about dates and include as much detail as possible to help the National Awards Advisory Group understand the situation.
This report details the brave actions of Keith who acted spontaneously to a call picked up on a hand‐held scanner from the Coastguard channel. As well as being a Scout he is also a member of the Royal National Lifeboat Institution inshore lifeboat crew.
On the evening of Wednesday 14 August, Keith was on a cycle ride with his father, close to the beach at Cotgrave‐on‐Sea. He had a hand‐held scanner with him, which was tuned in to the Coastguard channel. On the scanner, he heard that people had got into difficulties in the sea, not far from his location. Keith rushed to the scene and saw there were three people in the water. They were in difficulties at a point north of the outfall, and very close to a group of rocks, approximately 60 to 70 yards out to sea. There were two boys and one man in the water. Approximately 100 people were at the scene, observing but not reacting.
Realising the necessity for swift action, and without any consideration for his own safety, he entered the water.
2. Involvement in Scouts
Outline what the nominee does in/for Scouts and their usual character.
Keith is an 18 year old Assistant Leader and a member of the Scout Network. He helps run a successful Scout Troop and is an avid water activities fan – which is where most of his interest in Network stems from. Keith is slightly shy but knows his stuff and people respect his opinions.
3. Key achievements and outcome
What has the nominee achieved (for themselves or others) by dealing with the incident or despite their condition?
Keith swam out and successfully pulled in one of the boys. He then went back to rescue the second boy, who was in shock and screaming. Whilst bringing him to shore he saw that the third person, an older male, was having difficulties and had given up the struggle to keep himself afloat. With the second boy still in his care, Keith went to the rescue of the man, who was now unconscious in the water. He put his arm under the man’s chin and pulled his head above water. By now they were about 10 yards from the rocks and 50 yards from shore. With both casualties in his care and with great difficulty, he began the swim back to shore, calling to bystanders for help.
He then administered Cardiopulmonary resuscitation to the man until paramedics arrived. All those Keith rescued survived.
4. Personal challenges
Think about the main challenges or risks that the nominee has had to overcome. For acts of bravery did they put their life at risk, and if so, how? If undergoing treatment for a medical condition, how has this affected them and what is the long-term prognosis?
Keith, who was ‘off duty’ at the time of the incident, took decisive action to help the casualties despite great risk to his own life. It was a dangerous area of water and he had none of the usual rescue equipment with him.
5. Other community recognition
Outline any other recognition the nominee has received relating to the incident or condition described above. Examples could include: recognition from the emergency services or other organisations. Please also list the name and dates of any related awards received by the nominee.
The Royal National Lifeboat Institution are seeking recognition for Keith but as yet we are unaware of the outcome.
6. Witness statements/evidence
Detail all external support for this nomination. Examples could include: statements from eye-witnesses, the emergency services, doctors or medical specialists or newspaper cuttings etc.
The Royal National Lifeboat Institution’s detailed report is attached and clearly identifies the facts related to this incident and also the bravery and prompt actions of this young leader.
The newspaper article attached recounts the events and provided further evidence from the police that it was only Keith who took action in entering the water.