NSQHS Standards. Health service organisations submission for extensions to Advisory: AS24/01

NSQHS Standards. Health service organisations submission for extensions to Advisory: AS24/01

This form is for health service organisations being assessed to the NSQHS Standards to apply for extensions to the requirements of Advisory AS24/01 Reprocessing of reusable medical devices in health service organisations. Please note that Regulator input will be sought for each submission.

Name of Health Service Organisation*

NOTE: If you are submitting an extension for several facilities, please email AdviceCentre@safetyandquality.gov.au

Name of contact person*

Email address*

Contact number*

Please include an area code

Address

State or Territory*

Select

Name of Accrediting Agency*

Select

Accreditation expiry date*

Category for which exemption is being sought*

Select

Reason for requesting an extension*

Include adequate details of the circumstances for the application

Documents provided*

Please provide copies of your organisation's gap analysis, risk remediation and project plan with evidence that it has been approved by the organisation's executive or governing body.

Select

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The Australian Commission on Safety and Quality in Health Care collects personal information when the information is necessary for, or directly related to, the Commission’s functions or activities. All personal information is held and treated in accordance with the Australian Privacy Principles under the Privacy Act 1988 and the Commission’s Privacy Policy: https://www.safetyandquality.gov.au/about-us/governance/privacy-policy By submitting this form, I agree to the Commission collecting my personal details, as described above, for the administration of the NSQHS Standards Orientation Course. (Please tick box.)*

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