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Appendix 6: Sample Policies adapted from the Austin Hospital (NSW) Policies

Action Sheet: Missing Home Visit Staff Member

To be completed in the event that a Home visit staff member does not return to The employer in accordance with the policies and procedures in place for the outreach area.

Report date:

Report time:

Missing at or between the following hours:

on:

Details of Missing Staff Member

Name:

Date of Birth:

M / F

Address:

Telephone No.:

Work Location

Description

*Photograph available: Yes / No

Height:

Build:

Eyes:

Hair:

Complexion:

Clothing: Colour or Type of

Dress:

Skirt:

Trousers

Cardigan / Jumper:

Shirt / Blouse

Jewellery

Coat / Jacket:

Footwear

Other distinguishing features

Vehicle Details:

Vehicle Type

Model

Colour

Registration

Mobile Phone Details

Mobile phone: Yes / No

Number:

Home Visit Location Details

Date	Time	Destination	Confirmed

 

Last known destination:

Next of Kin Details

Name:

Telephone No

Relationship to missing staff member:

NOK contacted: *Y / N Time:

Comments:

Site Manager/AHSM

Site Manager / AHSM contacted: *Y / N

Name:

Time:

Comments

Police

Police Contacted: *Y / N

Time:

Officer

Station

Comments:

Outcome

Time:

Date:

Details:

Reporting Person

Name:

Position:

Signed:

Date:

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