RM67 – Policy for supporting staff involved in an

							                          RM67 – Policy for supporting staff involved in an incident, complaint or claim
                                                STAFF SUPPORT CHECKLIST
                                Please see section 2 for staff support for witness appearances
                                   To be retained by manager either in separate checklist file or employee’s personal file


Employee Job title(s)                                                      Division
Date of incident                                                           Department/Ward
Reason for support

Section 1 – all staff
1     Was immediate support/debriefing offered?

2     Was a copy of internal and external support agencies (appendix 2) highlighted to the employee(s)?                      Yes/no/NA

3     Was referral to the Occupational Health and Safety Department discussed with the employee(s)?                          Yes/no/NA

4     Was counselling support discussed with the employee(s)?                                                                Yes/no/NA

5     Have temporary role adjustments, redeployment or reassignment of duties been considered?                               Yes/no/NA

6     Has a second debriefing (24 - 48 hours) been offered and held with the employee(s)?                                    Yes/no/NA

7     Has further support been offered to the employee(s) (e.g. supervisor of midwives, chaplaincy, Trade Union)             Yes/no/NA

8     Has a Root Cause Analysis been carried out with appropriate support?                                                   Yes/no/NA

9     Has the need for ongoing or long term support been discussed?                                                          Yes/no/NA

10    Has(have) a referral(s) to Occupational Health and Safety been made for assessment about fitness to return to          Yes/no/NA
      work?
Section 2 – Witness appearances only. Has (have) the employee(s):
11    Been briefed about the process?                                                                           Yes/no
12    Been offered support in statement writing?                                                                Yes/no
13    Been offered support in preparation for appearing as a witness?                                           Yes/no
14    Have arrangements been made to make sure that the employee will be supported on the day of the hearing?   Yes/no
15    On conclusion of the case, was the employee debriefed (if the information was in the public domain)?      Yes/no
Any other comments