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 Cub 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: Jane Smith

1. Reason for the award nomination

On 28th September, while walking home from school, Jane Smith witnessed a serious road traffic accident on Manchester Road, an extremely busy main thoroughfare. A cyclist was struck by a vehicle and thrown violently onto the carriageway, lying unconscious in the path of oncoming traffic.
Jane immediately recognised the imminent danger to the casualty and to herself. She ran into the road, signalling for vehicles to stop while placing herself between the oncoming traffic and the injured cyclist, fully aware that she was exposing herself to considerable personal risk. Vehicles were still approaching at speed, and the road remained hazardous until traffic was fully halted.
Upon reaching the casualty, Jane assessed the cyclist’s condition and noted that they were struggling to breathe. Drawing on the first aid skills she had learnt as an Explorer Scout, she cleared the airway and placed the cyclist in the recovery position. Simultaneously, Jane instructed bystanders to call emergency services and assist in securing the scene, maintaining a safe perimeter around the injured person.
Throughout the incident, Jane remained calm and composed, providing reassurance to the casualty and bystanders, despite the stressful and dangerous environment. She continued to administer care until paramedics arrived, who later commended her actions, stating that her quick intervention had a direct impact on the casualty’s chances of survival. The cyclist was stabilised at the scene and later transported to hospital, where they made a strong recovery.
This incident demonstrates Jane’s exceptional bravery, presence of mind, and application of Scouting skills in a real-life emergency, undertaken at real risk to her own life.

2. Involvement in Scouts

Outline what the nominee does in/for Scouts and their usual character.

Jane Smith is an active member of her local Explorer Scout Unit and has consistently demonstrated dedication, responsibility, and leadership throughout her Scouting journey. She has successfully achieved her Bronze Duke of Edinburgh Award, showing commitment to personal development, community service, and practical skills.
In addition to her Explorer Scout activities, Jane serves as a Young Leader with her local Beaver Scout Colony, where she supports younger Scouts, helps plan and run activities, and acts as a positive role model. She is known among her peers and leaders for her reliability, maturity, and willingness to help others at all times.
Jane’s usual character reflects the core values of Scouting: she is compassionate, courageous, and conscientious. She consistently demonstrates initiative, a strong sense of service, and the ability to remain calm and thoughtful in challenging situations — qualities which were clearly evident during the incident on 28th September, when she acted decisively to protect and assist an injured cyclist.

3. Key achievements and outcome

What has the nominee achieved (for themselves or others) by dealing with the incident or despite their condition?

By her swift and courageous response to the road traffic accident on 28th September, Scout Jane Smith achieved several significant outcomes:
1. Immediate protection and care for the casualty – Jane placed herself at real risk by running into a busy road to shield the injured cyclist from oncoming traffic, preventing further harm.
2. Application of practical skills under pressure – Using the first aid training she had acquired as an Explorer Scout, she cleared the casualty’s airway and placed them in the recovery position, ensuring vital care before the arrival of emergency services.
3. Leadership and coordination at the scene – Jane calmly directed bystanders to call emergency services and help maintain a safe perimeter, demonstrating initiative and organisational skill in a high-stress situation.
4. Positive impact on the casualty’s recovery – The casualty was stabilised at the scene and later transported to hospital, where they made a strong recovery. Jane’s actions were specifically commended by paramedics as directly contributing to this outcome.
5. Reflection of Scouting values – Jane’s bravery and selflessness not only saved a life but also exemplified the principles of Scouting in action, highlighting the real-world impact of her training and character.
Through her courage, presence of mind, and application of Scouting skills, Jane achieved an extraordinary personal accomplishment while directly benefitting the life and well-being of another person.

4. Personal challenges

Scout Jane Smith faced considerable personal risk during the incident. While running into Manchester Road, an extremely busy main route, to assist a cyclist, Jane knowingly exposed herself to the possibility of serious injury or worse. Vehicles were still moving at speed, and she positioned herself between the casualty and oncoming traffic to prevent further harm.
Despite the immediate danger and high-stress environment, Jane remained calm and focused, prioritising the safety and care of the casualty over her own well-being. She applied first aid skills she had learned as an Explorer Scout under intense pressure, coordinated bystanders, and maintained control of the scene until professional help arrived — all while fully aware of the physical risk to herself.
Jane overcame the emotional and psychological challenge of witnessing a serious accident and responding to it in real time. She demonstrated extraordinary composure, courage, and decision-making at a young age, managing both the practical and emotional demands of the situation.
There are no ongoing medical conditions affecting her, but the risk to her life during the incident was real and substantial, highlighting the exceptional bravery and selflessness of her actions.

5. Other community recognition

Jane Smith has received significant recognition from both her community and professional emergency responders for her courageous actions:
• Commendation from paramedics – The attending paramedics explicitly praised Jane for her quick thinking, effective use of first aid, and bravery in maintaining the safety of the casualty until professional help arrived. They acknowledged that her intervention had a direct and positive impact on the cyclist’s outcome.
• Acknowledgment from local Scout leaders – Explorer Scout and Beaver Scout leaders formally recognised Jane’s courage and leadership, highlighting how her actions exemplify the values of Scouting.
• Local community and school recognition – Jane has been publicly acknowledged within her school and community for her bravery, including mentions in assemblies and newsletters, celebrating her as a role model for young people.

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 nomination for Jane Smith is supported by multiple sources of external evidence:
1. Statements from Eye-Witnesses – Several bystanders at the scene have provided accounts confirming Jane’s quick and courageous intervention, her use of first aid, and her efforts to protect the injured cyclist from oncoming traffic.
2. Paramedics / Emergency Services – The attending paramedics have formally commended Jane’s actions, highlighting her effective first aid, composure under pressure, and the direct positive impact on the casualty’s outcome.
3. Scout Leaders – Leaders from Jane’s Explorer Scout Unit and Beaver Scout Colony have provided supporting statements emphasizing her long-standing dedication, leadership, and commitment to helping others.
4. School / Community Acknowledgment – Jane’s school has issued recognition of her bravery through assemblies and newsletters, documenting her actions and reinforcing her status as a role model.
These statements and pieces of evidence provide clear external support for this nomination and validate Jane’s exceptional bravery, presence of mind, and selflessness during a high-risk emergency.

Silver Cross

Name: David Jones

1. Reason for the award nomination

On Saturday 12 October, a group of adult paddlers was undertaking a white-water kayaking trip when one member became trapped in a highly dangerous section of the river. The incident occurred at a dam-release river, where water was flowing forcefully through three large pipes, generating continuous, turbulent white water. The river was unpredictable, with eddies, submerged trees, and rapidly changing currents that created significant hazards even for the group of experienced paddlers.

During the trip, one paddler misjudged their approach to a gorge section and was swept against partially submerged trees, chest-deep in water. The force of the current pinned the kayak in place, leaving the paddler unable to move and with only intermittent access to air. The situation was immediately life-threatening.

David Jones responded with exceptional composure and courage. Without hesitation, he waded into chest-deep, fast-flowing water, fully aware of the danger to his own life. He quickly assessed the situation, recognizing the need for both immediate support and a structured rescue plan. David coordinated with his colleague, John, providing clear instructions to the trapped paddler while keeping them calm and focused. He evaluated the surrounding environment, identifying the safest route to approach the kayak, and prepared for a technically challenging extraction under extreme conditions. His ability to remain calm, think critically, and act decisively prevented what could have become a fatal incident.

2. Involvement in Scouts

Outline what the nominee does in/for Scouts and their usual character.

David is a long-standing Scout Network member and serves as Cub Section Team Leader at 1st Anytown Scout Group. Within the group, he is recognized for his calm, approachable demeanour, and his ability to inspire confidence and trust in both Scouts and fellow leaders. David’s leadership style blends enthusiasm with meticulous planning and risk management.

He mentors younger Scouts, modelling resilience, courage, teamwork, and selflessness. He ensures that all activities, from water-based challenges to land navigation, are conducted with strict attention to safety and preparedness. David’s dedication extends beyond formal roles; he actively fosters a culture of learning, responsibility, and emergency awareness among his peers and Scouts. His actions during the rescue exemplify the qualities he teaches daily calm leadership, courage under pressure, quick thinking, and methodical problem-solving in emergencies.

3. Key achievements and outcome

What has the nominee achieved (for themselves or others) by dealing with the incident or despite their condition?

David’s actions during the incident were decisive, skilled, and heroic. Upon seeing the paddler trapped, he immediately waded into chest-deep, fast-moving water and attempted to free the kayak manually. When this proved impossible due to the water’s force and the kayak’s positioning, he quickly adapted, designing a pulley system using nearby trees, ropes, slings, and karabiners. He calculated the mechanical advantage required to safely move the kayak and executed the plan with precision.

Throughout the rescue, David maintained constant communication with the paddler, offering clear instructions and verbal reassurance. His calmness prevented panic and allowed the paddler to conserve energy despite extreme physical strain and oxygen deprivation. David coordinated every movement with John, monitoring the paddler’s condition while simultaneously adjusting the rescue strategy to respond to the river’s ever-changing currents.

Once the paddler was successfully freed and brought to dry land, David immediately administered first aid, addressing shock, exhaustion, and oxygen deprivation. He ensured the paddler’s breathing, circulation, and mental state were stabilized until emergency services arrived. Paramedics later commended David for his exceptional composure, quick thinking, and professional handling of both the rescue and immediate medical care. His intervention undoubtedly prevented further harm and contributed directly to the paddler’s survival.

Following the incident, David shared a detailed account of the rescue with his local Scout Network, raising awareness of river safety, emergency preparedness, and teamwork during high-risk scenarios. His actions led to his nomination for a Royal Life Saving Award from the Royal Life Saving Society UK and have had a lasting impact on both the Scout community and the wider public.

4. Personal challenges

The rescue demanded extraordinary physical, mental, and emotional resilience. David faced multiple personal challenges:
• He had to wade into chest-deep, fast-flowing water, where the risk of being swept downstream was severe.
• He needed to make split-second, life-saving decisions under extreme stress, balancing his own safety with the need to rescue another person.
• The physical exertion required to control ropes, manage a pulley system, and maintain the paddler’s airway above water was immense.
• He had to maintain constant verbal reassurance to prevent panic while adapting to rapidly changing river conditions.
• Once the paddler reached dry land, he immediately provided first aid, requiring mental clarity after sustained physical and emotional exertion.
David overcame all these challenges through his exceptional fitness, training, experience, and calm temperament. His ability to remain composed, think critically, and act selflessly under life-threatening conditions exemplifies extraordinary bravery.

5. Other community recognition

David’s bravery has been recognized widely within his community. The Star, the local newspaper, published a detailed account of the rescue. The Lord Mayor personally visited a Scout Network meeting to commend David and John for their courage, technical skill, and quick thinking. Paramedics on the scene also formally acknowledged David’s professionalism, calmness, and decisiveness. These recognitions underscore the extraordinary impact of his actions on both the immediate safety of the paddler and the wider community. (Copy of newspaper 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 paddler whose life was saved provided the following detailed account:
“On the day of the incident, we were navigating a dam-release river with strong currents flowing through three pipes, producing continuous white water. At an eddy above the final gorge, I misjudged my approach and was pushed against partially submerged trees. I became trapped and struggled to keep my head above water. The force of the current made movement impossible.
David immediately waded into chest-deep water, attempting to free me. Despite the immense force of the water, he remained calm, shouting reassurance and coordinating with John. He set up a pulley system from a nearby tree, calculated the mechanical advantage, and, with extraordinary patience and strength, gradually freed me from the kayak.
Once we reached the riverbank, David immediately administered first aid. I was exhausted, oxygen-deprived, and in shock. His swift and competent care stabilized me and ensured my safety. When the paramedics arrived, they commended David for his calmness, quick thinking, and the way he managed the situation. Without David’s courage, skill, and composure, I would not have survived.”

Bronze Cross

Name: Keith Jamboree

1. Reason for the award nomination

On the evening of Wednesday 14 August, Keith, an 18-year-old Scout and Assistant Leader, was cycling along the beach at Cotgrave-on-Sea with his father. Carrying his hand-held Coastguard scanner, he suddenly heard a distress call: people were in grave danger in the sea nearby. Rushing to the scene, he saw three individuals—two young boys and an adult male—struggling violently in turbulent water, only 60–70 yards from jagged rocks. The currents were strong, the waves relentless, and the risk of immediate drowning was extreme.
Approximately 100 bystanders were present but remained frozen in fear. Fully aware of the life-threatening danger, Keith immediately entered the hazardous water, alone and without rescue equipment, relying on his instincts, training, and courage to prevent multiple fatalities.

2. Involvement in Scouts

Outline what the nominee does in/for Scouts and their usual character.

Keith is a dedicated Assistant Leader and active member of the Scout Network. He helps organize and run a wide range of activities for his troop, including camping, hiking, pioneering, survival skills, and water-based activities such as sailing, kayaking, and lifesaving. His expertise in water safety and rescue is particularly well-developed, and he regularly trains younger Scouts in these critical skills.
He has also led community initiatives, including beach clean-ups, first aid workshops, and safety awareness campaigns, fostering a sense of responsibility and civic duty among Scouts. Keith is known for his calm, thoughtful approach, technical knowledge, and mentoring abilities. These qualities—leadership, composure under pressure, and selflessness—directly enabled him to respond effectively during the life-threatening incident at Cotgrave-on-Sea.

3. Key achievements and outcome

What has the nominee achieved (for themselves or others) by dealing with the incident or despite their condition?

a) Rescue of the first boy
Keith entered the water and immediately reached the boy closest to shore, who was exhausted and panicking. Navigating turbulent waves and strong currents, he secured the boy and guided him safely to shore, preventing him from being swept under or dashed against rocks.

b) Rescue of the second boy
Without hesitation, Keith returned for the second boy, who was in severe shock and flailing uncontrollably. Each wave increased the risk of drowning for both the boy and Keith, yet he maintained control and guided him safely.

c) Rescue of the adult male
During this second rescue, Keith noticed the adult male was unconscious, drifting dangerously close to jagged rocks. Facing the near-impossible task of rescuing two people simultaneously, Keith positioned himself under the man’s chin to keep his airway above water while holding the second boy securely. Battling strong currents and waves, he moved both casualties toward shore, demonstrating remarkable strength, endurance, and composure under life-or-death conditions.

d) Life-saving treatment on shore
Once ashore, Keith immediately began Cardiopulmonary Resuscitation (CPR) on the unconscious man. He delivered precise chest compressions and rescue breaths, keeping the man’s airway clear and blood circulating, while simultaneously comforting the second boy, who remained in shock. His tireless efforts continued until paramedics arrived, giving the man the best possible chance of survival.

e) Overall outcome
Thanks to Keith’s courage, skill, and decisive action, all three casualties survived. His ability to make split-second decisions under extreme pressure, perform simultaneous rescues, and deliver life-saving treatment exemplifies extraordinary heroism.

4. Personal challenges

Keith acted “off duty,” without protective gear or rescue equipment, in a hazardous, rock-strewn stretch of sea. He knowingly risked his life in strong currents and turbulent waves while managing multiple panicked casualties. The physical and mental demands of keeping both a child and an unconscious adult afloat, then performing CPR on the man, were immense. His composure and selflessness under immediate mortal danger demonstrate exceptional courage and resilience.

5. Other community recognition

The Royal National Lifeboat Institution has formally recognized Keith’s bravery and nominated him for national awards. His actions stand out because he acted alone, under extreme risk, and in conditions that could have resulted in multiple fatalities. Recognition from RNLI and other community organizations is pending.

Keith has also received praise and commendation from emergency services, including local Coastguard officers and paramedics, who highlighted his quick thinking, courage, and lifesaving skill. Their statements emphasize that his intervention directly prevented multiple fatalities and exemplifies the highest standards of bravery and public service.

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 RNLI’s detailed report confirms Keith’s life-saving actions and the extreme danger involved. A newspaper article corroborates the events, noting that he was the only individual to enter the water while approximately 100 bystanders remained on the shore. Police statements confirm that without Keith’s intervention, the outcome could have been fatal for all three casualties. His bravery and skill are fully documented in multiple independent sources, underscoring the extraordinary nature of his heroism.