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Excellence in Social Initiative

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12 views5 pages

Excellence in Social Initiative

Uploaded by

gayatrimann
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© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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FICCI Healthcare Excellence Awards 2020 – 12th Edition

Application form – Excellence in Social Initiative

Category Category Definition Eligible Participants


To recognize the social initiatives which have resulted in Open to Hospital, Other
Excellence in the upliftment of the healthcare status in India. The Healthcare Service Providers,
Social Initiative initiative should have wider impact on the preventive/ NGO’s and Not for Profit
therapeutic and outcome-based healthcare scenario Organisations

Guidelines for the participant

1. Any organization participating in the Awards should be an Indian entity with a registered presence in India
2. The initiative should be completely executed in the Indian operations of the participant
3. The organization must have completed at-least 5 years of operations in India as on June 30, 2020. Any
start-up applying for the awards should have completed minimum of 2 years and maximum of 5 years of
operations in India as on June 30, 2020
4. Employees and immediate family members of the award management, sponsors and partners of the
awards are not allowed to participate in the Awards
5. Participation in the awards is subject to defined rules and regulations available on website
www.ficcihealthawards.com
6. To apply for the Awards participant should download the application from the website, fill it and upload
the completed application on the website or email it to healthawards@ficci.com ; prachi.pal@ficci.com
7. No hard copies of the application form will be accepted
8. All mandatory fields (*) of the application form needs to be complete in all respects
9. Entries will be accepted in English language only
10.Participant can send multiple application forms for same category or separate categories provided it is for a
separate initiative. A separate form should be used for each application entry. One form or same
information cannot be used for multiple projects / initiatives. If multiple entry forms are received for same
project / initiative, then only one form will be considered, and others will be disqualified
11.Please provide below documents to be eligible for the Awards. Supporting documents must be in the
mentioned formats only – pdf, doc, jpeg etc. Size of each document cannot exceed 2 MB per attachment.
Any document sent separately will not be accepted
 Picture/ Video and other details of the social initiative taken and its impact
 Date of incorporation and start date of initiative on organization letter head
 Any other document supporting the initiative
12.In case if participant fails to submit the proof of incorporation certificate of the participating entity and start
date of initiative on organization’s letter head, they may be disqualified from participation
13.In case of any queries relating to the application form or participation in the awards please contact:
Mr. Kapil Chadha Dr. Prachi Pal
kapil.chadha@ficci.com prachi.pal@ficci.com
+91 9654631600 +91 8368004375
FICCI Healthcare Excellence Awards 2020 – 12th Edition
Application form – Excellence in Social Initiative

Section 1 – Participant Information*

Level of Entry*  Group Level  Unit Level


Name of participating entity*

Type* Choose an item.

About the entity*


Address*

Presence in number of cities*


Year of incorporation (in DD/MM/YYYY) for
participating entity*

Website*

Revenue (INR crores) for participating entity in


 Less than 25  26 - 100  101 -250
 More than
the period Apr 1, 2019 to Jun 30, 2020* 250

Section 2 – Operational Matrix*

Detail 2017-18 2018-19 2019-20 Comments


Total number of Social initiatives
Number of hospital tie-ups to
promote social initiatives
Number of corporate tie-ups to
promote social initiatives

Section 3 – Case Study*

A) Summary of the initiative and its implementation*

1. Summarise the initiatives undertaken by the organization in regard to social excellence in healthcare
sector
i) Name of initiative (max 50 words)

ii) Initiative launch date (DD/MM/YYYY)


FICCI Healthcare Excellence Awards 2020 – 12th Edition
Application form – Excellence in Social Initiative

iii) Summary of initiative undertaken including below (max 500 words)


 Problem identified
 Challenges faced during implementation
 Details of the initiative
 Methodology adopted
 Cost involved to run the initiative
 Time frame to make the software/app available to use

iv) Who are your peer benchmarks in the industry for the initiative? Name any two. (Max 50 words)

B) Impact*
1. Describe the impact of above initiative on various parameters such as stakeholders, operations, business etc.
highlighting the followings (max 500 words):
A. Benefits of initiative to various stakeholders
B. Scale of implementation
C. Period of impact (whether the project has shown instant change or change over a period)
FICCI Healthcare Excellence Awards 2020 – 12th Edition
Application form – Excellence in Social Initiative

C) Sustainability/ Scalability*
1. Please describe the key developments from your end to ensure the sustainability and scalability of the
initiative in the long run (max 300 words)

Details of any other award/certification/ accreditation obtained by the organization with respect to initiative in the last
2 years (Please provide supporting documents) *
FICCI Healthcare Excellence Awards 2020 – 12th Edition
Application form – Excellence in Social Initiative

Section 4 – Declaration *
I/we hereby declare that the details furnished in the application form and supporting documents submitted
for FICCI Healthcare Excellence Awards 2020, are to the best of my knowledge and belief true, correct and
complete. In case any of the said information is found to be false or untrue or misleading or
misrepresenting, I am/we are aware that I/we will be held liable for it.
I/we declare that below is true:

 The date of incorporation of the organization is ______________________


 Initiative mentioned in the application is completely executed and fully implemented in the period
April 1, 2018 to June 30, 2020
 The impact demonstrated and results showcased by initiative is in the period April 1, 2019 to June
30, 2020

I/we, on behalf of my/our organization, <name of organization>, authorise FICCI to use the content
submitted as part of my/our nomination, in whole or in part and use and display such entry, which shall
include trade publications, press releases, electronic posting to the awards website, electronic hyperlinks to
the website of the participant, and any display format selected by FICCI during the awards ceremony or at a
later point in time, for a period of five years.

I/we further agree that the information provided has been approved by the Registrar or equivalent
personnel of my/ our institution

Participant Name: _______________________________

Designation: ___________________________________

Date: _________________________________________

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