INTAKE

Open a case

Twenty two structured questions. Plan ten to fifteen minutes. Your answers are stored privately. The signing psychologist reviews the intake before accepting the engagement.

Parties

Name of the hospital or healthcare group. *

Your full name (HR Director or delegated lead). *

Your work email. *

Pseudonym we should use for the named nurse in the report (e.g. Nurse A). Do not enter a real name. *

Job title and ward of the named nurse. *

Do you commit to disclosing the full signed report to the grievance panel if requested? *

Incident

Type of matter. *

Date of the precipitating incident (YYYY MM DD). *

One paragraph summary of what occurred and what the nurse alleges. *

Paste the verbatim grievance text (or note that it is uploaded as a file). *

Roster Context

Contracted shift pattern (e.g. 4 nights on 4 off, fixed days, rotating). *

Contracted weekly hours. *

Typical nurse to patient ratio on the unit during the 90 days preceding the incident.

Name and title of the immediate supervisor during the 90 day window.

How are handovers documented on this unit (verbal, written sheet, electronic record)?

Procedural History

Which clauses of Cabinet Resolution 1 of 2022 has either party invoked?

List any prior written or verbal warnings issued to this nurse, with dates.

Has a formal internal investigation been opened? If so, who chairs it?

Has a grievance hearing been scheduled or held? Provide dates.

Any documentation you know to be missing (signed warnings, hearing minutes, etc.).

Documents

In what format is the 90 day roster being supplied (Excel, PDF export, scheduling system export)?

In what format is the attendance log being supplied (badge in/out CSV, manual sign in sheet scans, HRIS export)?

Cancel

By submitting you confirm that the named nurse is identified only by pseudonym in this system.