On Call file note tool 2015

• Document No.

• Conducted on

  Date

Stage 1 - Critical information

• Hello, focus on call, this is...

• Activate time stamp of call

  Date

• What is the reason for this call?

  Select Cat 1 incident Cat 2 incident Client health related Emergency maintenance Medication related Provision of general information Seeking information / authorisation Staffing related

  • Cat 1 incident
  • Cat 2 incident
  • Client health related
  • Emergency maintenance
  • Medication related
  • Provision of general information
  • Seeking information / authorisation
  • Staffing related

• Is this a life threatening situation?

  Yes

  No

• Have emergency services been contacted?

  Yes

  No

• If yes, which departments?

  Select Victoria Police MFB / CFA SES Ambulance Poisons Information

  • Victoria Police
  • MFB / CFA
  • SES
  • Ambulance
  • Poisons Information

• What time did you call the emergency services?

  Date

• Have emergency services responded?

  Yes

  No

• If yes, what time did they arrive?

  Date

• Do you require further on site support?

  Yes

  No

Stage 2 - Incident information

• Client(s) involved

• Location of incident

  Select Ash Flat Ash House Balcombe Banksia Berry Flat Berry House Bondi Bungower Cedar Flat Cedar House Century In Community Hartigan Maysbury Oak Flat Oak House Olsen Oppy Outreach Pine Seaview The Rise

  • Ash Flat
  • Ash House
  • Balcombe
  • Banksia
  • Berry Flat
  • Berry House
  • Bondi
  • Bungower
  • Cedar Flat
  • Cedar House
  • Century
  • In Community
  • Hartigan
  • Maysbury
  • Oak Flat
  • Oak House
  • Olsen
  • Oppy
  • Outreach
  • Pine
  • Seaview
  • The Rise

• Cat 1 or Cat 2 incident - What type?

  Select Absconding Physical Assault Property Damage Self Harm Sexually inappropriate Verbal Abuse Fire Death (client) Death (employee) Other

  • Absconding
  • Physical Assault
  • Property Damage
  • Self Harm
  • Sexually inappropriate
  • Verbal Abuse
  • Fire
  • Death (client)
  • Death (employee)
  • Other

• Client health related - What type?

  Select Injury Hospitalisation Missing Seizure Illness Diabetes Deterioration of known condition

  • Injury
  • Hospitalisation
  • Missing
  • Seizure
  • Illness
  • Diabetes
  • Deterioration of known condition

• Emergency maintenance - What type?

  Select Building damage Water outage Power outage Gas leak Electricity hazard Flooding / storm damage Uncontrolled animal Vehicle breakdown Appliance malfunction Fallen trees

  • Building damage
  • Water outage
  • Power outage
  • Gas leak
  • Electricity hazard
  • Flooding / storm damage
  • Uncontrolled animal
  • Vehicle breakdown
  • Appliance malfunction
  • Fallen trees

• Medication related - What type?

  Select PRN request PRN no effect PRN missing Emergency insulin Error - Family Error - Incorrect client Error - Incorrect dose Error - Missed dose Error - Client refusal Error - Spilt medication

  • PRN request
  • PRN no effect
  • PRN missing
  • Emergency insulin
  • Error - Family
  • Error - Incorrect client
  • Error - Incorrect dose
  • Error - Missed dose
  • Error - Client refusal
  • Error - Spilt medication

• Staffing related - What type?

  Request for additional staff

  Failed to attend shift

  Illness while working

  Overstaffed

  Personal emergency

• Provision of general information? Provide details...

• Staff member seeking information? Provide details...

Stage 3 - Response to caller

• Type of response

  Select Allocated extra staff Authorised PRN administration Contacted emergency services Denied PRN administration Recorded general information Supplied adequate information Denied request for extra staff Referred to emergency services Non-emergency

  • Allocated extra staff
  • Authorised PRN administration
  • Contacted emergency services
  • Denied PRN administration
  • Recorded general information
  • Supplied adequate information
  • Denied request for extra staff
  • Referred to emergency services
  • Non-emergency

• Provide details of response

Stage 4 - Post call actions

• On call receiver - Signature

  Sign

• On call receiver - Verify time and date

  Date