EVE LIMITED POLICY AND PROTOCOL FOR

Transcription

EVE LIMITED POLICY AND PROTOCOL FOR
Eas
t
er
nVoc
at
i
onalEnt
er
pr
i
s
esLi
mi
t
ed
Cr
eat
i
ngCont
ext
sf
orRec
ov
er
y
Ver
s
i
on2
Ref
:
EVE033
Introduction
Methodology
Section 1:
1.1
1.2
Section 2:
2.1
2.2
2.3
2.4
2.5
2.6
2.7
2.8
2.9
2.10
2.11
2.12
Section 3:
3.1
3.2
3.3
3.4
3.5
Section 4:
4.1
4.2
4.3
4.3
4.4
Section 5:
5.1
5.2
5.3
5.4
Section 6:
6.1
6.2
6.3
6.4
Section 7:
7.1
7.2
7.3
7.4
7.5
7.6
7.7
7.8
7.9
Activity Plan
Planning the Activity
Activity Risk Assessments
Organising the Activity
Staff Ratios
Code of Conduct
Activity Leader
Consent to Travel
Activity File
Mobile Phones
Vehicle Usage
I.D Card
Holiday Record Card
Emergency Money
First Aid
Map & Locations
Emergency Procedures
Agreed Emergency Plan
Group Briefings
Dietary Requirements
Dignity and Respect
Staff Guidelines
During the Activity
Itinerary
‘Buddy’ System
Procedural Checklist
Maintaining Control in the Event of an Emergency
Alcohol / Drugs & Illegal Substances
Evaluation
Activity Evaluation document
Debriefing Sessions
Retention of Records
Database of Activities
Documentation & Unaccompanied Outings
Planning the Activity
Organisation of the Activity
Evaluating the Activity
Unaccompanied Outings
Appendices
Activity Objective Form
Abroad Activity Objective Form
Sample Risk Assessment
Sample Consultant / GP cover Letter
Consultant / GP Consent Form
Participant Consent Form
ID Card
Holiday Card
Working Group Schedule of Meetings
Guidelines for Community Activities, 2009
Page 2
Page 2
Pages 3 - 4
Page 3
Page 3
Pages 4 -7
Page 4
Page 4
Page 5
Page 5
Page 5
Page 5
Page 6
Page 6
Page 6
Page 7
Page 7
Page 7
Pages 8 - 9
Page 8
Page 8
Page 8
Page 9
Page 9
Pages 9 - 12
Page 9
Page 10
Page 10
Page 11
Page 12
Pages 12 - 13
Page 12
Page 12
Page 12
Page 13
Pages 13 - 14
Page 13
Page 13
Page 14
Page 14
Pages 15 - 25
Page 15 - 16
Page 17 - 18
Page 19
Page 20
Page 21
Page 22
Page 23
Page 24
Page 25
The primary aim of the Community Based Social Activities Working Group was to draft a
comprehensive policy, outlining the procedures and protocol for all staff and participants who
engage in community based activities. It is anticipated that the content of this document will
determine the pertinent issues which must be considered, when staff and participants engage
in activities within their own community and the wider community in Ireland and Europe.
Activities both on and off site during core / non-core hours have become a common feature
of service delivery in EVE Ltd. Staff and participants of EVE Ltd have demonstrated an
increasingly creative approach to excursions which may be of a social, cultural or educational
nature.
The following policy was developed in partnership and consultation with all staff and
participants within EVE Ltd, social partners, HSE and Irish Public Bodies Insurance Ltd.
Working Group meetings were held on a number of occasions (see appendix 8). Staff
members and participants of EVE Limited were invited to make submissions, which were then
reviewed and incorporated into this document.
In their aim to emphasise and reinforce safe practise, and the requirements necessary to
facilitate safe and successful outcomes for all activities, the working group have identified and
incorporated best practise into the recommendations found in the body of the this document.
The document essentially provides a breakdown of the necessary steps required when
embarking on an excursion, from the initial planning of the activity to the final evaluation of the
activity and is outlined as followed:
Section 1:
Section 2:
Section 3:
Section 4:
Section 5:
Section 6:
Planning the Activity
Organising the Activity
Framework for Emergency Procedures during Activities
During the Activity
Evaluation of the Activity
Suggested Documentation & Unaccompanied Outings
Guidelines for Community Activities, 2009
A crucial element of a successful outing is careful planning. All proposed activities must be
discussed and agreed with the Centre Manager and where deemed appropriate the Regional
Manager and Finance Manager.
All proposed overnight activities must first be discussed and agreed upon by the Regional
Manager and Finance Manager. They in turn will relay information to the General Manager.
Trips abroad must be approved in writing by the General Manager. Overnight activities in
Ireland will be approved by the relevant Regional Manager once the funding is in place.
As part of the planning process, an Activity Risk Assessment must be undertaken prior to the
commencement of the activity. This must be completed in consultation with the Centre
Manager and staff.
An Activity Risk Assessment will include the following*:
a)
b)
c)
d)
e)
f)
g)
Client profile assessment
Number of clients taking part in activity
Ratio e.g. number of staff to clients (identify number of staff required)
Risk assess mode of transport
Risk assess destination
Risk assess planned activities
Risk assessment put in place (for activities of 2 days or more) in relation to medication
considerations
Due consideration must be given to the planned itinerary and the profile of those taking part in
the activity. It is imperative to have as much participant involvement as possible at this stage.
Where a Risk Assessment identifies a moderate to high risk, it is advised that the Manager
and staff should reconsider or alter the activity in order to reduce the risk to the minimum
acceptable level. Advice from the Regional Manager may be requested at this stage. If it is
not possible to alter or change the activity to achieve minimum risk standards, abandoning
arrangements altogether may have to be considered.
Guidelines for Community Activities, 2009
Written objectives defining the aim and purpose of the activity must be agreed upon by those
taking part, prior to the actual event. The function of this step is two-fold, it will ensure that the
aim of the activity is achieved and moreover, that the evaluation and de-briefing stages can
be conducted adequately and effectively on return to the centre.
*Please note that this may not be an exhaustive list and other factors may need to be taken into consideration
based on individual locations/activities.
To achieve a safe participant to staff member ratio, Centre Managers and staff members
should consult the knowledge and expertise of those participants who intend to take part in
the proposed outing, prior to the activity. This will be the responsibility of the Centre Manager.
Staff members involved are required to address both the logistics of the event and the
suitability of the activity with regard to transport, access and facilities. A guideline of 1:5 (plus
1 other staff member in attendance where practicable) is recommended for activities. This
ratio may be revised and is dependant on the staff member - participant risk assessment.
Consideration must be given to the nature and type of activity. For example, if the proposed
activity is abroad, the communication skills of both the staff members and participants may be
compromised and pose additional risks, this in turn may require additional staff members,
thus increasing the staff member - participant ratio. Please note that all trips abroad are
required to have a minimum of 3 staff members in attendance.
Staff supervising and in attendance of the activity are required to draw up a “Code of
Conduct” which stipulates the expected standard of behaviour and how inappropriate
behaviour should and will be dealt with. The Code of Conduct may vary from centre to centre.
The code of conduct will include such issues as:
•
•
•
•
•
•
•
Punctuality;
Hygiene;
Accommodation;
Alcohol;
Sexual Activity;
Sickness;
Medication.
Guidelines for Community Activities, 2009
A group leader must be appointed before departure. The nominated person will have
responsibility for decision making whilst on the activity. The group leader must have relevant
knowledge of all participants taking part, and in addition relevant experience of participation in
activities is necessary. All staff members will uphold the authority of the appointed leader for
the period of the activity. The group leader’s decision is final and all involved are obliged to
respect this.
Where activities are abroad (or accommodation is overnight away from the participants own
residence) medical approval to travel shall be sought and a consent form must be completed
by the participant’s Doctor on each occasion. It is advisable to attach a cover letter detailing
the schedule of events to the Consent Form [see Appendix 4, page 20]. An appropriately
devised letter must be produced
A Doctor’s consent form must include consent to travel, disclosure of any relevant medical
conditions and any medication required by the participant on the trip (if applicable). This
information will be considered when conducting the risk assessment when deciding on staff to
participant ratios. This information may also be useful should a participant require medical
assistance or in the event that medication is lost or stolen [see Appendix 5: Consent Form,
page 19].
A record detailing the contact details of staff and participants attending the outing must be
kept and should include address, contact number and next of kin. A copy will be supplied to
all staff members taking part in the activity. A copy should also be held in the centre in an
activity file which should be accessible to all staff members remaining in the centre. A copy
should also be forwarded to the Regional Manager and kept in a master file accessible to all
Regional Managers/General Manager or the responsible officer.
The centre mobile should be used for local activities; however it would be desirable that
attending staff would be in possession of two mobile phones. It is imperative that the roaming
function is enabled prior to departure for activities taking place abroad (this may involve
contacting the relevant phone operator of the country you are in).
Guidelines for Community Activities, 2009
To ensure a prompt response to any event, emergency and useful numbers should be stored
to the phones memory. Should a staff member be required to use their personal phone in the
event of an emergency, they will be reimbursed for any expenses incurred. Any participant’s
who have mobile phones should be asked to furnish staff with their numbers for the duration
of the trip as this will assist in contacting all participants should they become separated from
the group.
All usage of company vehicles shall be governed by the revised Organisational Policy (Feb
2007). Only where a risk assessment dictates and when deemed necessary there should be a
minimum of 2 staff memebrs in the company vehicle.
Ideally a centre pocket ID card should be issued in advance of the activity to all individuals
who will be attending. This will include a passport size photo, individual’s name, address,
organisational details, contact number of the centre and Regional Manager. For overnight and
trips abroad the name, address and phone number of the hotel must be included. This
information should be in both English and the relevant countries language (if applicable). In
the future it is envisaged that a standardised ID card will be issued [See Appendix 7: I.D.
Card, page 23]. Should the participant have a difficulty using a centre ID card, or the centre
does not have a centre ID card developed then a Garda ID card can be used.
For overnight trips abroad a record should be completed for all staff and participants prior to
the groups’ departure. This will include details such as the individuals’ name, address, date of
birth, medical card number, EHIC card number, private medical insurance number,
medication, passport number etc. This record will also have two passport photos, one affixed
and the other detachable.
In the event of an individual becoming lost, the detachable photograph may be given to the
relevant authorities and the second affixed photo can be used to enquire locally in the search
by staff. These records are to be held by the group leader [see Appendix 8: Holiday Card,
page 22]. Where the risk of separation from the group is high, for instance in a crowd
situation, it may be useful to consider other identifying features such as a coloured t-shirt or
cap/bag.
Guidelines for Community Activities, 2009
Participants and staff members will agree to carry a nominal sum of emergency money on
their person at all times during the activity. This figure should be agreed prior to the trip and
will essentially allow for provisions such as food, beverages or a taxi, should an individual
become detached from the group.
An appropriate ‘travel’ first aid kit (adequately stocked) should be carried on all activities
where practicable. It is vital to give consideration to the number of individuals in attendance
and secondly to the nature of the activity itself. A qualified first aid person should be in
attendance where practicable and should ideally carry the ‘travel’ first aid kit. All participants
should be made aware of this individual’s identity prior to departure.
A detailed map of the relevant areas the group will visit should be sourced prior to the group’s
departure, if deemed necessary e.g. day trip away, short break way or foreign holiday.
Important locations and information for example meeting points, accommodation, areas the
group will visit, should be highlighted and explained to individuals prior to departure. This map
should be easy to read and each individual should receive a copy, if deemed necessary.
Guidelines for Community Activities, 2009
Emergencies by their very nature are often sudden and unexpected, however the effects of
such events can often be significantly minimised by implementing a procedure and
conducting comprehensive pre-emptive risk assessments.
This should include contact names of those to call during any 24 hour period, designated
meeting points and times during the activity, and designated ‘lost points’ should be identified
for each location the group will travel to. If travelling by mini-bus, the group should practice an
emergency evacuation prior to the activity taking place, if deemed necessary. The role and
responsibilities of the group leader should also be clearly defined. In the event of an incident,
a member of the Management Team or the appointed officer of EVE Limited will be appointed
as the official contact person.
Where the group are on an overnight stay, short break or holiday (within Ireland or abroad) all
plans for the following day should be communicated and discussed with all individuals on a
daily basis. This should also be seen as an opportunity to discuss and reiterate emergency
protocol, so that all group members are aware of what is expected of them and also which
procedures to follow in the event of an emergency.
Where the group are going on a local activity / day activity plans should be communicated
and discussed with all individuals prior to the trip.
All staff members should be made aware of issues pertinent to participants general well being
for example, diabetes, asthma etc.
Guidelines for Community Activities, 2009
Every member of the group should be made familiar with the appropriate Code of Conduct
that has been agreed upon prior to departure (Ref: 2.2). All group members should have an
input into the development of this Code of Conduct, so as they can understand and practise
its content. Staff and participants must treat each other with respect and dignity at all times.
It is expected that all staff members operate within the best practice guidelines set out by EVE
Ltd in the Staff Handbook. This outlines the individual responsibilities and conduct expected
of all staff members whilst performing their duties in their workplace or whilst on social or
educational excursions.
Once the activity has been thoroughly planned and emergency procedures and safeguards
have been established and put in place, it is important to follow these procedures during the
activity. The procedures to ensure that everyone has an enjoyable and safe trip are as
follows:
Before departure the importance of full participation and co-operation by staff members and
participants alike should be explained, discussed and agreed.
Each service user and staff should be issued with a copy of the itinerary and other relevant
documents for the activity, for example, a map, contact numbers etc.
Guidelines for Community Activities, 2009
In order to maintain an optimum level of safety a ‘buddy system’ should be implemented
whilst on excursions if appropriate. Essentially, each participant user should be paired up with
another / other participants. A record of these pairs will be kept by the group leader.
Participants will have a responsibility to stay with their ‘buddy’ and this responsibility must be
communicated to them. If they get separated from their buddy, they must immediately inform
a staff member. If the initial pairing is not satisfactory to participants, then a facility should be
in place to review the situation. Each staff member will have a specific group of participants
allocated to them.
It should be noted that not all participants will want to participate in a ‘buddy system’. If this is
the case a contact number for them should be held by the staff member and an identified
meeting point and time should be agreed by both parties should the participant wish to avail
of personal time e.g. personal shopping time, watch a different movie in the cinema (if on at
the same time) etc.
1. Pre-designated meeting points and times will be decided on a daily basis.
2. Pre-designated ‘lost points’ should be decided on a daily basis. All participants must be
advised on procedures to follow in the event they become separated from the group or
find themselves in danger. These may vary dependant on the activity.
3. All staff and participants will carry pocket ID which will include contact numbers of staff
(Ref: 2.8).
4. If the outing is out of the local area (e.g. holiday away within Ireland or abroad) a map
should be provided to each individual. This should highlight important areas such as
meeting points, lost points, accommodation, proposed route of the group etc.
5. It is advisable that room allocations for overnight stays are agreed upon prior to departure.
If possible all rooms should be together and all service users should be aware of staff
member’s room and hotel telephone numbers and given instruction on how to contact
same.
6. Please note that if a client should have a difficulty / problem whilst in the hotel they must
telephone the allocated staff members room and not go to his/her room.
7. Staff should note that if there is an issue with a participant whilst in the hotel this should be
dealt with in a public place e.g. the foyer and not in the participant’s room if possible;
however in the interest of all parties dignity this can also be carried out in the participants
room with two staff members and another participant (at the selection of the participant
concerned).
Guidelines for Community Activities, 2009
8. Consider a time check e.g. every two hours; “Are we all here?” or before travelling to a new
location.
In the event that an emergency occurs during an activity, the designated group leader should
try to maintain or resume control of the whole group as quickly as possible. Consideration
should be given to the following:
1. Ascertain the seriousness and nature of the emergency as quickly as possible. If a
medical emergency is involved identify any casualties and seek medical attention. Where
possible, a staff member should accompany the injured party to the appropriate medical
facility to give any relevant medical information. The rest of the group should be kept
together with adequate supervision at all times.
2. Notify the police or relative / appropriate authorities if necessary.
3. Ensure that all group members follow the emergency procedures and carry out all the
tasks allocated to them, roles can be re-allocated as necessary.
4. In the event of an emergency, the EVE organisational contact person will be informed by
an attending staff member. The organisational contact will be responsible for making
decisions or arrangements based on the nature of the incident / emergency.
5. The organisational contact will then decide whether or not to make immediate contact with
the family of a person involved in an incident. In the case of a lost person, it could cause
unnecessary worry. However in the case of an injured person, the family should be given
a full and factual account of the incident as soon as possible and assured of information
updates.
6. The organisational contact person should notify insurers especially if medical assistance is
required and if abroad, ensure that the Irish Embassy is aware of the incident as they
could offer expert assistance.
7. All relevant facts should be recorded as soon as possible, an Accident/ Incident report
form must be completed and this must include any witness details etc. It is important to
preserve any evidence that could prove vital to a future investigation. Keep a detailed
written account of all events, times and contacts made after the incident as an
investigation may follow. Contact the Local Authority Inspector or Health Service
Executive or equivalent where appropriate.
8. No person within the group may speak to the media. Persons involved in the incident
should not be identified as this may cause added unnecessary distress to themselves or
their families and may contravene the organisation’s official process of notification.
9. At no time should any member of the group discuss liability or accept liability with any
other parties in relation to the incident. Under no circumstances should any documentation
Guidelines for Community Activities, 2009
be signed. Any enquiries should be referred to the organisational contact person who will
have access to legal advice.
10. All receipts for any incurred expenses should be retained for submission to insurers on
return.
Staff members of EVE Limited are not permitted to consume alcohol or take illegal drugs
whilst engaged in community activities, as this may lead to impairment of the staff member’s
ability to carry out their duties and responsibility to provide a duty of care to participants. No
individual engaged in the community activity (staff or member) is permitted to be in
possession or under the influence of illegal drugs.
When a group returns from an activity they must complete an Activity Evaluation document
which for quality assurance and best practise purposes, will function to evaluate whether the
aims and outcomes of the outings were achieved. This document will refer to the objectives
and planning of the visit, health and safety provisions, document the negative and or positive
outcomes and learning points gained from the visit.
It is recommended that an informal / verbal debriefing session should be conducted following
short outings. This session will replace a more formal debriefing session or review for a full
day trip or overnight stay(s) both at home or abroad, at the earliest opportunity. A formal
debriefing document and review should be completed at the earliest opportunity upon return
of overnight / holiday trips.
The Evaluation Document will be kept in the activity file within the centre. If there are issues
in relation to the activity and its evaluation, details are to be forwarded to the Regional
Manager / General Manager. These reports are valuable documents which may form an
integral part of the centres Annual Review.
Guidelines for Community Activities, 2009
It is recommended that a database of activities and experiences of activities, excursions,
educational trips/ venues be established. This will serve to inform others and share
experiences of various activities.
There are a variety of documents which must be completed and stored before, during and
after a proposed trip. The list below summarises the documents you are required to complete
and at what stage you should complete them.
1. Activity Objective Form: Outlines the objectives of the particular activity [see
Appendices 1 & 2, pages 13 -16] (to be used for day trips, beaks away and foreign
holidays).
2. Activity Risk Assessment: Includes number of participants, level of group, staff ratio,
nature/location of activity, mode(s) of transport, age of participants, budget, duration of
activity / trip etc. [see Appendix 3, page 17] (to be used for all trips).
3. Authorisation for overnight and foreign travel: Authorisation from General Manager and
Regional Manager is required. Submissions include itinerary, risk assessment, centre
cover, etc.
1. Itinerary / Schedule of Events: This should include departure times, break times and
venues, meeting times, lost points etc. (to be used for day trips, beaks away within
Ireland and foreign holidays).
2. Consent Forms – GP & Participant [see appendices 4 & 5, pages 20 & 21] (to be used
for breaks away within Ireland and foreign travel).
3. ID Card [see Appendix 7, page 23] (to be used for all trips).
4. Holiday Card [see Appendix 8, page 24]
5. Activity File: Details of staff and participants accessible to centre staff and copy of
same to Regional Manager (to be used for day trips, overnight stays, breaks away
within Ireland and foreign holidays).
Please note: it is imperative that these documents are also carried during the trip by each individual.
Guidelines for Community Activities, 2009
1. Database: Established in Emmet House (organisational): To inform/share experiences
of various activities.
2. Evaluation of the Activity.
It is acknowledged by all staff members that unaccompanied outings for the purposes of self
directed learning are an integral part of training and rehabilitation. As part of the programme
staff members are responsible for conducting a Risk Assessment before approving the
activity.
Guidelines for Community Activities, 2009
Location of activity:
Date:
Purpose of activity:
Objectives of activity:
Signed:
Date:
EVALUATION OF ACTIVITY
Signed:
Guidelines for Community Activities, 2009
Date:
Location of activity:
Carlingford
Date:
10.05.06
Purpose of activity:
To enable service users to enjoy a day trip
and engage in activities enjoyed by the
community at large.
Objectives of activity:
1. To experience a day trip on a coach
2. To visit sights of cultural interest
3. To visit shopping centre
4. To enjoy an evening meal and entertainment
Signed:
Mary Gibbs
Date:
10.05.06
EVALUATION OF ACTIVITY
The day trip was a huge success. All service users enjoyed the trip. The guide on the bus
was very interesting and showed a huge interest in the group. The meal in the hotel was
lovely and is definitely a trip we will do again
Signed:
Mary Gibbs
Guidelines for Community Activities, 2009
Date:
12.05.06
Location of activity:
Date:
Purpose of activity:
Objectives of activity:
1.
2.
3.
4.
Signed:
Date:
EVALUATION OF ACTIVITY
Signed:
Guidelines for Community Activities, 2009
Date:
Location of activity:
Rome Italy
Purpose of activity:
To provide an opportunity for a short
holiday and experience a different
culture/country
Date:
13-16.09.06
Objectives of activity:
1. To experience an overnight holiday with friends.
2. To experience a different culture e.g. food, language,
environment, transport.
3. See famous sights e.g. Vatican city, Coliseum.
4. Audience with the Pope.
Signed:
Ann Marie Gillespie
Date:
06.09.06
EVALUATION OF ACTIVITY
This was an excellent trip. It was great to see participant coping with language barriers
and tasting different foods. Everyone enjoyed the sight seeing. In the future maybe we
would have less on the itinerary list as we had a lot to take in.
Signed:
Ann Marie Gillespie
Guidelines for Community Activities, 2009
Date:
18.09.06
1.
GROUP PROFILE
ƒ Eight participants, 3 in their 30’s and 5 in their late 20’s.
ƒ All participants’ have been to the golf course on numerous occasions and are
aware of safety procedures.
ƒ Group are of similar age interest and ability.
ƒ 2 Staff will travel with group.
2.
RISK FACTORS
ƒ
ƒ
ƒ
ƒ
3.
Injury from slips trips and falls
Injury from golf balls
Do participants get on well with each other?
Weather - sunburn, dehydration are these going to be factors?
MODE OF TRANSPORT
ƒ MPV
Duration 2 hours 11.00am – 1.00pm
Guidelines for Community Activities, 2009
24th January 2007
Dr. Xx,
Xx,
Xx,
Dublin 8.
Re: John Smith (change as appropriate)
Dear Dr. Xx,
John Smith (change as appropriate) is currently attending our training centre.
We are presently organising a weekend break (change as appropriate) to Galway
(change as appropriate). We are departing on Thursday 4th May and will be returning
on Wednesday 10th May (change as appropriate).
In order for us to ensure we are fully prepared we need to complete a number of
assessments and have certain information to hand so that all health and safety issues
are in order. Please note that John (change as appropriate) has given his consent for
me to approach you for the information required (copy of consent form enclosed).
I would be obliged if you could complete the enclosed Medical Consent form and return
it to me by return of post in the self-stamped envelope provided.
Should you require further information please do not hesitate to contact me on (01)
XXXXXXX. Many thanks in advance.
Kind regards,
_________________
Centre Manager
Guidelines for Community Activities, 2009
Participant Name: __________________________
D.O.B_________________
Consultant / GP Name: ______________________
Contact Number:____________
Community Nurse* Name: ____________________
Contact Number:____________
1.
In your professional opinion do you feel the above named person is in a fit &
suitable condition to attend and participate in the centre activity to
______________________ for the duration of ________ day(s)?
Please circle: Yes
2.
No
Is the above named person self medicating?
Please circle:
Yes
No
If no, can you ensure that all their medication needs are taken care of prior to
departure on _______________?
3.
Please list any significant medical, psychiatric or other Diagnosis for the above
person (other than on their EVE medical report):
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
4.
Please give details of medication the person is taking and daily dosage:
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
5.
Has he /she any special requirements which you feel we ought to be aware of, for
example, dietary requirements, medication etc? If yes please elaborate
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
Consultant / GP Signature: _____________________________
*Or other appropriate nominated person
Guidelines for Community Activities, 2009
Date: ____________
I,
____________________________________________________________
give
permission to my Consultant / GP (_______________________________________) to
disclose all relevant information to the Manager of
__________________________
regarding my psychiatric diagnosis and the current medication I am taking. This
information will only be used if required whilst on a Centre Activity.
Signature: _________________________________________
Date: ____________________________________________
Guidelines for Community Activities, 2009
Sample I.D. Card
Name:
Johnny Cash
Centre name member
Address:
26 Folsom Prison
Reno
California
USA
D.O.B.
12.02.1982
Tel:
00 353 1 7776667 (Home Landline)
00 353 86 7659512(Mobile)
Next of Kin: Gimme Cash - Mother
(Above address & Home Landline)
Guidelines for Community Activities, 2009
Insert Centre
logo here
Samples:
I am staying at: (Je reste à )
Hotel Address: (Adresse)
Hotel Comfort Art Siru Brussels
Place Charles Rogier 1,
1210 Sint-Joost-ten-node
Brussels
Telephone (Téléphone): (+34) 93/2768310
Contact: Staff name
No: XXXXXXX
Staying and attending the XXXXX Conference in the Marriott Hotel
from Sunday 7th until Thursday 11th December 2008
Hotel:
Glasgow Marriott Hotel
500 Argyle Street, Anderston, Glasgow, G3 8RR, UK
Telephone: 0044-141-226-5577
In case of emergency please contact:
Staff name (Title)
Glasgow Marriott Hotel 0044 141 226 5577 OR
00 353 87 XXXXXXX OR 00 353 86 XXXXXXX
Insert centre name and address here
Telephone: 00 353 1 xxxxxxx
Guidelines for Community Activities, 2009
1.
2.
3.
10th March 2005
12th April 2005
10th May 2005
Guidelines for Community Activities, 2009