It was established by the Government of Ontario in 1973 to recognize people who, through exceptional long-term efforts, have made outstanding contributions to the well-being of their communities and whose assistance is given without expectation of remuneration or reward.

Originally established as the Province of Ontario Medal for Good Citizenship, the decoration was renamed in 2024 to honour the late Queen Elizabeth II.

[2] Recipients are selected by an independent advisory council, which has the lieutenant governor of Ontario as its honorary chair.

No elected federal, provincial, or municipal representative may be awarded the decoration while such person remains in office.

The decoration may not be awarded posthumously unless the Advisory Council had selected the recipient prior to their death.