What you advise as your primary area of expertise or specialist knowledge base? What other areas of experience do you have? please choose a maximum of 5 – Additional areas of Theatres & safety ☐Medicine ☐Operating ☐Health experience care ☐Surgery ☐Critical ☐Radiology care ☐Maternity ☐Emergency ☐Oncology risk ☐Paediatrics ☐Clinical ☐HR health ☐AHP ☐Governance ☐Mental services services ☐Hotel ☐Pharmacy ☐Addiction (GP) disabilities management ☐Community ☐Learning ☐Risk (Nurse) homes ☐Community ☐Care ☐other If other, please state Why would you like to become a CHKS surveyor? Please provide the name and contact details of a referee. Thank you. On completion please save and email a copy of this form to together with a copy of your CV. CHKS use only A ☐ D ☐
What you advise as your primary area of expertise or specialist knowledge base? What other areas of experience do you have? – please choose a maximum of 5 Additional areas of experience ☐Medicine ☐Operating Theatres ☐Health & safety ☐Surgery ☐Critical care ☐Radiology ☐Maternity ☐Emergency care ☐Oncology ☐Paediatrics ☐Clinical risk ☐HR ☐AHP ☐Governance ☐Mental health ☐Hotel services ☐Pharmacy ☐Addiction services ☐Community (GP) ☐Learning disabilities ☐Risk management ☐Community (Nurse) ☐Care homes ☐other If other, please state Why would you like to become a CHKS surveyor? Please provide the name and contact details of a referee. Thank you. On completion please save and email a copy of this form to together with a copy of your CV. CHKS use only ☐ A ☐ D
CHKS%20Survey%20Selection%20application%20form%202017.docx