WDHS Request to attend external events

1
Please be aware visits to external events facilities will require approval from the Chief Executive. All submissions are sent directly to the the Chief Executive to review.
2
Department Head name* This field is required.
First Name
Last Name
3
Department Head Email* This field is required.Please enter your department head email
example.lastname@wdhs.net
4
Department Head contact number
5
Department* This field is required.
Accounting & Finance
Acute Ward Coleraine
Acute Ward Penshurst
ADASS Coleraine
Aged Care Corporate
Anaesthetics
Birches
Chiropody/Podiatry
Clinical Placement
Coleraine Hotel Services
Coleraine Nursing Home
Community Aged Care Packages
Community Health Hamilton
Community Liaison
Community Rehabilitation
Complex Care
Continence
Corporate Services
Counselling
Diabetes Education
Dietetics
Discharge Support Service
District Nursing
Divisional Heads or Executive
Education Centre
Emergency Department
Food Services - Hamilton
Food Services Coleraine
Food Services Penshurst
Grange Extended Care
Hamilton House
Health Information
HMO
Hotel Services
Human Resources
Improvement & Innovation
Infection Control
Infectious Diseases - COVID-19
Intensive Care Unit
Kolor Lodge
Maintenance Hamilton
Maintenance Coleraine
Maintenance Penshurst
Medical Administration
Medical Unit
Mens Health
Merino Bush Nursing Centre
Midwifery Model
National Centre Farmer Health
Nurse Relievers
Nursing Administration
Occupational Therapy
Oncology Outpatients
Operating Theatres
Palliative Care
Payroll
PCP
Penshusrt Nursing Admin
Personal Services Assistants
Pharmacy
Physiotherapy
Quality & CMO office
Sleep Clinic
Social Support Group
Social Work & Welfare Services
South West Community Transport
Speech Therapy
Staff Cafeteria
Sub-Regional Corporate Service
Supply
Surgical Unit
Switchboard
Transition Care Package
Volunteer Coordinator
Wannon Hostels
Western District Linen Service
WJ Lewis
Womens Health
Youthbiz
6
Event title* This field is required.
7
Event location / venue / accommodation details* This field is required.
8
What COVID risk mitigation measures will be in place?* This field is required.
Rapid Antigen Test
Eye protection
Mask
Social dist.
Staff name
Staff 1
Row 0, Column 0
Row 0, Column 1
N95
Surgical
Row 0, Column 2
Row 0, Column 3
Row 0, Column 4
Staff 2
Row 1, Column 0
Row 1, Column 1
N95
Surgical
Row 1, Column 2
Row 1, Column 3
Row 1, Column 4
Staff 3
Row 2, Column 0
Row 2, Column 1
N95
Surgical
Row 2, Column 2
Row 2, Column 3
Row 2, Column 4
Staff 4
Row 3, Column 0
Row 3, Column 1
N95
Surgical
Row 3, Column 2
Row 3, Column 3
Row 3, Column 4
Staff 5
Row 4, Column 0
Row 4, Column 1
N95
Surgical
Row 4, Column 2
Row 4, Column 3
Row 4, Column 4
Staff 1
Staff 2
Staff 3
Staff 4
Staff 5
Rapid Antigen Test
Row 0, Column 0
Eye protection
Row 0, Column 1
Mask
N95
Surgical
Row 0, Column 2
Social dist.
Row 0, Column 3
Staff name
Row 0, Column 4
Rapid Antigen Test
Row 1, Column 0
Eye protection
Row 1, Column 1
Mask
N95
Surgical
Row 1, Column 2
Social dist.
Row 1, Column 3
Staff name
Row 1, Column 4
Rapid Antigen Test
Row 2, Column 0
Eye protection
Row 2, Column 1
Mask
N95
Surgical
Row 2, Column 2
Social dist.
Row 2, Column 3
Staff name
Row 2, Column 4
Rapid Antigen Test
Row 3, Column 0
Eye protection
Row 3, Column 1
Mask
N95
Surgical
Row 3, Column 2
Social dist.
Row 3, Column 3
Staff name
Row 3, Column 4
Rapid Antigen Test
Row 4, Column 0
Eye protection
Row 4, Column 1
Mask
N95
Surgical
Row 4, Column 2
Social dist.
Row 4, Column 3
Staff name
Row 4, Column 4
1 of 5
9
Please outline travel arrangements & COVID risk mitigation strategies* This field is required.
Should be Empty: