Supplementary Material
The Supplementary Material
This Supplementary Material is a collation of contracts, forms, questionnaires, checklists etc currently in use by CRCs.
The Supplementary Material has been gathered together for ease of reference. Many CRCs indicated they wanted to be able to see the forms, checklists, contracts, etc that other CRCs were using.
The Supplementary Material has NOT been redrafted or edited in any way.
In the development of the Sample Manual many CRCs in NSW and the ACT indicated a preference for the development of some standard sample contracts, forms, etc. Transforming the Supplementary Material into Sample Standard Forms, Contracts etc is a possible task for the future.
The CRCs in NSW and the ACT have given permission for the Supplementary Material to be freely copied by Carer Respite Centres and other non-profit organisations in developing their policies and procedures.
Downloads
A.
CRCs & Carers
1.
Referral, assessment and contact details
Referral
Form 1
(2 pages 26k) Word
- Client
Information and Referral - Inner West CRC
Referral Form 2
(1 page 12k) Word
- Referral
- Far West CRC
Referral Form 3
(1 page 61k) - Referral Form - Hume CRC
Referral Form 4
(1 page 41k) - Carer Enquiry Sheet - Riverina Murray CRC
Assessment
1 (6
pages 22k) Word -
Needs Assessment - Far West CRC
Carer
Details 1
(2 pages 15k) Word
- Comprehensive
Information Sheet - Southern Highlands CRC
Carer Details 2
(2 pages 22k) Word
- Carer
Profile - Southern Highlands
Carer Details 3
(3 pages 31k) Word
- Confidential
Client Information - Far West CRC
Carer Details 4
(7 pages 259k) - Client Information System - ACT CRC
Carer
Details 5
(2 pages 14k) Word --
Carer Information - Far North Coast CRC
Carer
Details 5A
(2 pages 14k) Word
-- Carer
Information (contd) - Far North Coast CRC
OH&S
Checklist 1
(2 pages 11k Word --
Occupational Health and Safety Checklist
2.
Carer process checklist
Carer
Checklist 1
(1 page 33k) - South East Sydney CRC
3.
Client Service Agreement
Carer
Agreement 1
(1 page 80k) - Carer agreement for services - Illawarra CRC
Carer
Agreement 2
(1 page 22k) Word --
Carer agreement for services - Far North Coast CRC
4.
Emergency Respite Care Plan
Emergency
Care Plan 1
(4 pages 25k) Word --
Illawarra CRC
5.
Residential Respite Information
Residential
Respite 1
(1 page 10k) Word
-- Illawarra
CRC
6.
Carer complaints
Complaints
Record Form 1
(4 page 32k) Word -Illawarra
CRC
B.
CRCs and brokered service providers
1.
Service provider Information
Service
Provider Information 1
(1 page 29k)
2.
Brokerage service contract
Contract
1 (11
pages 377k) - Northern Sydney CRC
Contract 2
(11 pages 1040k) - Far North Coast CRC
Contract 3
(24 pages 1350k) - Benevolent society - South East Sydney CRC
3.
Request for brokered services
Service
Request 1
(1 page 9k) Word -
Illawarra CRC
Service Request 2
(4 pages 106k) - South East Sydney
(Including request for change and cancellation)
C.
Evaluation
1.
Written client feedback form.
Carer
Survey 1
(7 pages 35k) Word -
South Western Sydney CRC
Carer Survey 2
(3 pages 12k) Word -
Illawarra CRC
Carer Survey 3
(3 pages 21k) Word -
Far North Coast CRC
Carer Survey 4
(1 pages 13k) Word -
Far West CRC
2. Service Provider Questionnaires
Service Provider
Questionnaire 1
(1 pages 6k) Word
- New
England CRC
D. Staff
Staff orientation
Staff
Orientation Checklist
(2 pages
20k) Word -
South Western Sydney CRC