Document ID: chunk:federal_register_of_legislation:F2022L01161:schedule:1:p3
Version: federal_register_of_legislation:F2022L01161
Segment Type: schedule
Provision Reference: sch 1 (pt 3/6)
Character Range: 8687–12097

to have any actual or perceived conflict of interest between your role as an approved program provider and any other interest?

If 'yes', what are the details of this conflict?

What steps will you take to manage this conflict?

Professional misconduct or criminal proceedings
Have any professional misconduct, discipline, criminal or civil proceedings ever been commenced against you, or anyone engaged or caused to be engaged by you, in relation to your work as a rehabilitation program provider?

If 'yes', please provide details of any charges or complaints and the results of any proceedings.

Please also provide reasons why Comcare should not reject your application.

Insurance currency
Please provide the following documentation and details
      * Professional Indemnity Insurance
      * Public Liability Insurance
      * Workers Compensation Insurance
(For each State or Territory of operation as applicable, if you have an exemption please indicate for which State/Territory)

Financial solvency
Does your organisation have, or is it likely to have, financial difficulties that may impact its financial solvency or ability to provide workplace rehabilitation services?
If 'yes', please provide details of the issues that may impact your organisation's financial solvency.

PART B – CONFORMING TO THE CRITERIA AND ANY CONDITIONS OF APPROVAL

Note. This part refers to a person being 'relevantly qualified'. This is an important concept that is defined in subsection 6(4) of the Criteria. Please ensure that you understand this concept before completing this section.

Person in senior management to be relevantly qualified
If you are approved to provide rehabilitation services, you will be required to have at least one person as part of your senior management who is:
      * 'relevantly qualified', and
      * has at least five years' experience providing workplace rehabilitation services as a 'relevantly qualified' person.
Please provide the details in relation to that person:
Name:                                                                                                                                               Title:
Qualifications demonstrating that the person is 'relevantly qualified':
      * Relevant qualifications
      * Professional registration number/professional membership number/accreditation number (as applicable)
Details of that person's experience providing workplace rehabilitation services as a 'relevantly qualified person':
      * Please attach a resume

Relevantly qualified
Please provide the following details for any person engaged, or who would be engaged, by you to provide rehabilitation program services should your application be approved:
      * Name
      * Relevant qualifications
      * Professional registration number/professional membership number/accreditation number (as applicable)
      * Has the consultant attended Comcare training for approved rehabilitation program providers?
      * If yes, month and year of attendance
      * Has the consultant had more than 12 months experience providing workplace rehabilitation services?
      * If no, identify the name and contact details of the relevantly qualified consultant responsible for supervision

Policies and practices - Induction, supervision and professional development

Please outline how your organisation:
   -          inducts new consultants
   -