PHC Staff Nametag Order Form

Providence Health Care Employee Nametag Order Form

*Who is this request for?
Please confirm the employee's preferred name and pronouns if submitting on their behalf.

Employee Information

*Last Name

*First Name

*Email address

Employee ID number (if known)

Nametag Information

*Preferred First Name to be printed on nametag.
First name only, last name will not be printed.

Pronouns (Optional)
Consider including pronouns to promote inclusivity and acknowledge gender diversity, to learn more watch this video.

Title to be printed on nametag.
Choose title from the dropdown list. If it's not listed select 'other,' you will be directed to enter your title manually.

*Pin back or a magnet back?
Staff on Mental Health units should have a magnet for safety reasons.

Delivery Information
Nametags are delivered to worksite/department.

*Work Site (Location)
Choose site from the dropdown list. If it's not listed select 'other,' you will be directed to enter the site manually.

*Department/Unit
(eg. 7AB, Food Services, Emergency, Residential Care-1)

*Manager/Educator/Supervisor's Name

Manager/Educator/Supervisor's email (if known)

Room/Office Number (If known)