LIFESTYLES
LIFECHOICES
OOHC
THIRD PARTY
JOINT INVESTIGATION
QUALITY OF CARE - REVIEW TEMPLATE
Section 1: Incident Report Details
Date of Incident:
Date Reported:
OCP ALERT:
Time of Incident:
Date/Time Registered by DHHS:
MEMBER STATUS:
FMS ENTRY NO:
Incident Type:
N/A
Details: (e.g. Staff to Client)
IR REGISTER NO:
Section 2: Client Details
ORGANISATION:
Address:
First Name:
Date of
Birth:
Aboriginal/TSI:
1. Client Surname:
CRIS No.
2. Client Surname:
First Name:
Date of
Birth:
Aboriginal/TSI:
CRIS No.
3. Client Surname:
First Name:
Date of
Birth:
Aboriginal/TSI:
CRIS No.
Section 3: ONCALL Investigation Panel (**PRIMARILY RESPONSIBLE FOR FULL INVESTIGATION & FOLLOW UP)
Executive Manager
People & Culture
CEO
Other
**CHAIR PERSON:
Title/Relationship
Name
Phone
1st
Mtg:
2nd
Mtg:
3rd
Mtg:
ONCALL Responsible Rep
KEY CONTACTS
Labour Hire Org.
DHHS QoC
Coordinator
Case Manager
LEO
Staff Member
Staff Member Support
Person
Client Contact
Police
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Section 4: Investigation Planning Group (IPG) (NOTE: MEETING TO OCCUR WITHIN 3 DAYS))
Name
Position & Title
Contact Details
Meetings scheduled
Section 5: Staff Member Details
Witness
Participant
Victim
Witness
Participant
Victim
Witness
Participant
Victim
1.Staff Surname:
Employment
Status:
Rostered
Casual
2. Staff Surname:
Employment
Status:
Rostered
Casual
3. Staff Surname:
Employment
Status:
Rostered
Casual
First Name:
Contact Number:
Length of
Service with
ONCALL:
Previous
Incidents
/ QoC:
First Name:
Contact Number:
Length of
Service with
ONCALL:
Previous
Incidents
/ QoC:
First Name:
Contact Number:
Length of
Service with
ONCALL:
Previous
Incidents
/ QoC:
Number:
Date(s):
Number:
Date(s):
Number:
Date(s):
Section 6: Brief Summary of Alleged Concerns:
IR Report to be attached
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Section 7: Actions Taken:
No.
Item
Timeline
s
1.
Child Protection Case Manager / LEO been notified?
24 Hours
2.
Has the child / young person been informed of the concerns
and action taken? (OOHC)
24 Hours
3.
Has the child / young person’s parents been informed of the
concerns and action to be taken? (OOHC)
24 Hours
4.
Has a report been made to police?
24 Hours
5.
Did the child / young person require a medical assessment?
(attach relevant reports)
24 Hours
6.
Has the staff member(s) been stood down?
(OCP / Member Status updates)
24 Hours
7.
Has DWES been notified?
24 Hours
8.
Has the staff member(s) been informed of the concerns and
action to be taken (note whether via telephone, email or
letter)? What types of support have been offered?
24 Hours
9.
Will the Investigation Planning Group (IPG) meet?
Who will attend on behalf of ONCALL?
**Initial Screening – Investigation Planning Group
(Note details, names, meeting dates, etc.)
No
Staff Member
Responsible
(note if DHHS
responsible for
action)
Date
Completed
Details or Outcome
3 Days
10.
Will the child / young person be interviewed?
3 Days
11.
If child is Aboriginal / TSI, has the appropriate support
services been contacted?
3 Days
12.
Has the child / young person received an apology from the
staff member? From ONCALL? (Note whether verbal or
written)
3 Days
13.
Will the staff member(s) be interviewed?
3 Days
14.
Have other witnesses / relevant people been interviewed?
3 Days
15.
Is DHHS or ONCALL completing an independent investigation
(s81/82 CYFA)? If Yes, who will undertake this task? If no,
provide details as to whether the concern will be considered
for a possible report at a future date?
3 Days
16.
What are the primary issues and considerations to be covered
by the investigation and how will these be managed?
3 Days
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Yes
Not
Applicable
3
No.
17.
Item
Quality of care concern: Investigation Planning Group record
Timeline
s
Yes
No
Not
Applicable
Staff Member
Responsible
(note if DHHS
responsible for
action)
Date
Completed
Details or Outcome
7 Days
**Outcome of initial investigation:
Provide rationale details
18.
Summary of Actions taken:

(Action one)

(Action two)

(Action three)

Staff member status (note update on OCP).
Communication provided to staff member (note via
letter, email or telephone)

LEO informed?
7 Days
19.
Quality of care concern: Formal care review outcome report –
review of recommendations / action plan
28 Days
20.
Quality of care concern: Formal care review outcome report
28 Days
21.
***Letter to staff member (L.4) outcome
28 Days
22.
Quality of care concern: Formal care review outcome report –
review of action plan
3
Months
23.
Quality of care concern: Process review report
3
Months
**Note possible outcomes:




Take no further action
Recommend that concerns be managed via support and supervision
Recommend a formal care review
Commence an investigation
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