SCHEDULE 5 Agency report on Service Provider performance – Agency letterhead is to be inserted HERE (The Agency name, address and logo is to be clearly visible) Clause 27 of the Scheme Conditions provides that Agencies must, at the completion of any Agency Referral, submit a Performance Report for each engagement if: the Service Provider has breached the Scheme Conditions; performance of Services by the Service Provider is or has been unsatisfactory; and/or a critical aspect of the performance of the Service Provider is or was unsatisfactory. Agencies should follow all the steps outlined in clause 27 of the Scheme Conditions to ensure that they observe procedural fairness in the course of performance reporting. Information on this requirement is outlined in the Scheme Guide for Agencies. PROJECT DETAILS Service Provider’s business name: Service Provider’s telephone number: Description of Service provided: Date Service commenced: Date Service completed: Total Fee for this service (including GST): $ EVALUATION met not met Aspect of service were were were which did not meet satisfactory N/A standard level a expectations to acceptable good Unsatisfactory met an a Requirements Acceptable Good Description Requirements Requirements standard to to Time e.g. unable to meet deadlines, resourcing, planning, reporting Management Management & e.g. inappropriately skilled or inexperienced. suitability of personnel
SCHEDULE 5 – Agency report on Service Provider performance Agency letterhead is to be inserted HERE (The Agency name, address and logo is to be clearly visible) Clause 27 of the Scheme Conditions provides that Agencies must, at the completion of any Agency Referral, submit a Performance Report for each engagement if: the Service Provider has breached the Scheme Conditions; performance of Services by the Service Provider is or has been unsatisfactory; and/or a critical aspect of the performance of the Service Provider is or was unsatisfactory. Agencies should follow all the steps outlined in clause 27 of the Scheme Conditions to ensure that they observe procedural fairness in the course of performance reporting. Information on this requirement is outlined in the Scheme Guide for Agencies. PROJECT DETAILS Service Provider’s business name: Service Provider’s telephone number: Description of Service provided: Date Service commenced: Date Service completed: Total Fee for this service (including GST): $ EVALUATION Aspect of service which did not meet expectations N/A Unsatisfactory Requirements were not met to a satisfactory level Acceptable Requirements were met to an acceptable standard Good Requirements were met to a good standard Description Time Management e.g. unable to meet deadlines, resourcing, planning, reporting Management & suitability of personnel e.g. inappropriately skilled or inexperienced.
employment-related-medical-services-scheme-agency-report-supplier-performance.docx