Nomination
of auditor
Nomination for approval (to be completed by the practitioner)
I, (insert title and full name of practitioner here), nominate (insert title and full name of nominee here) to
be approved to act as an auditor as required under my (tick and complete applicable option/s):
☐ schedule of conditions, effective from (insert date conditions came into effect here)
☐ schedule of restrictions, effective from (insert date restrictions came into effect here).
By signing this form, I confirm the following:
1.
The nominee meets the Health Ombudsman’s criteria to act as an auditor as outlined below and
in my schedule of conditions/schedule of restrictions.
2.
I have provided the nominee with a copy of my schedule of conditions and/or schedule of
restrictions and a copy of the Office of the Health Ombudsman’s Nominee acknowledgement form.
3.
I am aware the Office of the Health Ombudsman will seek reports from the approved auditor
after each and every audit for the purpose of monitoring my compliance with my schedule of
conditions and/or schedule of restrictions.
4.
I am aware that if the nominated auditor is approved, I must provide an audit plan developed by
the approved auditor, outlining the form the audit/s will take and how the areas of concern for the
Health Ombudsman will be addressed.
5.
The nominee is (tick and complete the applicable option/s)
6.
☐
a registered health practitioner who holds registration with the (select relevant board)
Board of Australia—AHPRA registration number (insert number here)
☐
an unregistered health practitioner who holds accreditation with, and/or is a member of,
(insert full name of the relevant professional institute/association/accrediting body/other
(please specify).
The nominee is eligible to act as an auditor as the nominee
a.
is at least 18 years of age
b.
does not have a close collegiate, family, social, contractual or financial, or treating
relationship with me
c.
has provided a copy of their curriculum vitae to demonstrate they have suitable training,
experience and/or qualifications in order to provide the audit required
d.
does not have any current conditions, undertakings or restrictions on their registration
and/or right to practise as a result of disciplinary action
e.
has not been the subject of any adverse findings in previous disciplinary proceedings
f.
satisfies any additional criteria outlined in my schedule of conditions and/or schedule of
restrictions.
Signature:
Date: Click here to enter a date.
Please return this form with required attachments to the Office of the Health Ombudsman.
Office of the Health Ombudsman
v
Email: [email protected]
Call:
07 3158 1329
Fax:
07 3319 6350
Post:
PO Box 13281 George Street
Brisbane Qld 4003