Triage in the Community licence form

Section 1: Order Details
NART SKU [HIDDEN]
COMMUNITY SMALL SKU [HIDDEN]
COMMUNITY SMALL WT SKU [HIDDEN]
COMMUNITY MEDIUM SKU [HIDDEN]
COMMUNITY MEDIUM WT SKU [HIDDEN]
COMMUNITY LARGE SKU [HIDDEN]
COMMUNITY LARGE WT SKU [HIDDEN]
Licence type*

Community TriageNursing and Residential Triage
Community Triage comes in three bands depending on the size of the facility. The amount quoted is a one-off fee.

You can choose a licence on its own or add training for up to 4 instructors for an additional one-off fee of £200.
Package required*

Small: 50 residents or fewer £100Small : 50 residents or fewer plus instructor training £300Medium: 51 -100 residents £150Medium: 51 -100 residents plus instructor training £350Large: 101 residents or above £200Large: 101 residents or above plus instructor training £400
Type
ShortType
Name of organisation*
Name of your organisation as you want it to appear on the MTS online platform*
Address line 1*
Address line 2
Town*
Postal code (if applicable)*
Country*
Lead contact - full name*
Lead contact - job title*
Lead contact - email address*
Lead contact - phone number*
Product
sku1
saleprice
Number of licenses
Always 1
Total (£)

Section 2: Invoice details
Purchase order number*
IMPORTANT: Many organisations will not pay invoices without a purchase order number. Include a purchase order number here if you have one. Failure to do so may delay delivery of your course materials. If your organisation does not require a purchase order number, type your initials and the date here to indicate that.
SendElectronicInvoice*
Are the invoice details the same as the contact details in Section 1?*

YesNo
Invoice email*
example@example.com
Invoice contact number*
Invoice recipient name*
Invoice recipient company or trust name*
Invoice address line 1*
Invoice address line 2
Invoice city*
Invoice postcode*
Invoice country*
The obligation clauses in the licence specific to MTS {licenceType} are:
1. To deliver provider level training courses within the named Organisation to support the implementation and audit of the MTS Triage tool(s) listed above within that Organisation
2. To ensure that all staff implementing the MTS Triage tool(s) listed above have undertaken the structured provider level training programme
3. To log completion of the training on www.triagenet.net
4. To apply the MTS Triage regulations and carry out audit
5. To submit audit and compliance data annually
6. To have at least two Triage instructors who have completed the recognised training programme and will then be responsible for training staff in the use of the MTS Triage tool(s) listed above
7. To ensure that the version of MTS Triage used within the Organisation is compliant with update requirements as detailed in the appropriate update document. These are available on www.triagenet.net and the links will be emailed to you when you submit the licence agreement form
8. To make payments as agreed within standard payment terms
9. To inform MTG/ALSG if contact details change to ensure timely notification of updates
10. To ensure that the copyright notice and acknowledgement provided by MTG/ALSG shall appear in a prominent place every time the Work is accessed.
Serious Incident Occurrence Information

User has applied the tool, but during the investigation it has been found the tool was not applied in the way it was trained/taught

If use of the tool does result in a serious incident, this should be fed back to ALSG & the tool advisory group at the earliest possible opportunity
I confirm that I have read the specific clauses related to the use of MTS and am happy to proceed on that basis

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