Primary incident type <Enter primary incident type here > [As identified in the incident report] Secondary incident type (if required) <Enter secondary incident type here > [As identified in the incident report] [If there are multiple clients involved in the incident and multiple incident types leading to the RCA review, list all] Victoria Police response Was the incident reported to Victoria <Enter Yes/ No/NA here> Police? Date of report to Victoria Police <Enter the date reported to Victoria Police here> [DD/MM/YYY] If the incident was not reported, rationale <Enter rationale for not reporting here> for not reporting If the incident was reported to Victoria Police: Proposed Victoria Police action <Enter the details of proposed Victoria Police action> What timeframe was provided by Victoria <Victoria Police may choose to make initial inquiries prior to Police to conduct their investigation? launching an investigation. It is important to follow up regularly to ascertain the status of these inquiries and potential commencement of an investigation> Have Victoria Police agreed to the client, <Enter the details of advice provided by Victorian Police regarding staff or other people being interviewed as interviews> part of this RCA review (if required)? Root cause analysis (RCA) review approach Review period Proposed review start date <Enter the proposed review start date here> [DD/MM/YYY] Proposed completion date <Enter the proposed review completion date here> [DD/MM/YYY] [A provisional due date will be provided by the department divisional [Within 60 working days of the department office upon endorsement of the recommendation to undertake a RCA endorsing the recommendation to conduct review in response to a impact incident] an RCA review] Proposed RCA review methodology [Refer to Chapter 5 of the Client incident management guide for further information regarding RCA review methodology] Establishing the review approach Defining the problem [Provide a more detailed description of the problem to be addressed.
Primary incident type [As identified in the incident report] <Enter primary incident type here > Secondary incident type (if required) [As identified in the incident report] <Enter secondary incident type here > [If there are multiple clients involved in the incident and multiple incident types leading to the RCA review, list all] Victoria Police response Was the incident reported to Victoria Police? <Enter Yes/ No/NA here> Date of report to Victoria Police <Enter the date reported to Victoria Police here> [DD/MM/YYY] If the incident was not reported, rationale for not reporting <Enter rationale for not reporting here> If the incident was reported to Victoria Police: Proposed Victoria Police action <Enter the details of proposed Victoria Police action> What timeframe was provided by Victoria Police to conduct their investigation? <Victoria Police may choose to make initial inquiries prior to launching an investigation. It is important to follow up regularly to ascertain the status of these inquiries and potential commencement of an investigation> Have Victoria Police agreed to the client, staff or other people being interviewed as part of this RCA review (if required)? <Enter the details of advice provided by Victorian Police regarding interviews> Root cause analysis (RCA) review approach Review period Proposed review start date <Enter the proposed review start date here> [DD/MM/YYY] Proposed completion date [Within 60 working days of the department endorsing the recommendation to conduct an RCA review] <Enter the proposed review completion date here> [DD/MM/YYY] [A provisional due date will be provided by the department divisional office upon endorsement of the recommendation to undertake a RCA review in response to a impact incident] Proposed RCA review methodology [Refer to Chapter 5 of the Client incident management guide for further information regarding RCA review methodology] Establishing the review approach Defining the problem [Provide a more detailed description of the problem to be addressed.
Root-cause-analysis-review-plan-template-CIMS.docx