Authorised Person Details

Name of AP

Hospital Location
Enter date of assessment

Is this person acting as the Co-ordinating AP (MGPS)

Date of last assessment
Please note that this checklist is a hypothetical example and provides basic information only. It is not intended to take the place of, among other things, workplace, health and safety advice; medical advice, diagnosis, or treatment; or other applicable laws. You should also seek your own professional advice to determine if the use of such checklist is permissible in your workplace or jurisdiction.