Form Builder

Your browser does not appear to support JavaScript. You may want to try one of the following:

Turn on JavaScript in your browser if it supports it.
Use a browser that supports JavaScript.
Try a JavaScript-free version of this page, if made available by the application author.

Help

$xforms-template-label$$xforms-template-help$$xforms-template-hint$$xforms-template-label$$xforms-template-help$$xforms-template-hint$

Application NameISSUE Form NameOFI_QI Form TitleOFI-QI Form Form DescriptionThe opportunity for Improvement is the primary reporting mechanism for the organisation.The form is to be used for both opportunity for improvement (OFI) and quality improvements (QI).

Form Structure

Text Controls

Typed Controls

Date and Time

Selection Controls

Attachments

Buttons

Advanced

It appears that you are using Internet Explorer or earlier. Form Builder is likely not working properly with this browser. We recommend you upgrade to Internet Explorer or newer, or use Google Chrome, Firefox, Safari, or Opera. If we made a mistake and you are not using Internet Explorer or earlier, please let us know.

Form Settings

General Details

Originator Name

Date

If yes, please link Audit to this formIs this OFI/QI raised as a result of an Audit?

Is there a risk associated with this issue?

Please link the audit report

Please provide details of risk

ISSUE DETAILS

Describe your concern, frustration or issuePlease provide a clear, brief description including any relevant information that may help illustrate your concern or issue. Complete a separate form for each suggestion.

	Attachments
	Attachments

Do you have any suggestions, solutions or countermeasure?

suggestion

Suggested corrective action, solution or countermeasurePlease provide a solution or any ideas you may have that will correct this situation or assist in addressing your suggestion for improvement or concern

Justification for suggestionState any anticipated benefits / savings you believe will result should your suggestion or solution be implemented, e.g. time saving, compliance improvement, cost saving etc

ASSESSMENT

Conduct Risk Assessment?

This is the highest rating among all Assessed RisksCurrent Risk Rating

Indicator

		Risk	Consequence	Indicator
	Link	Risk	Consequence	Indicator

Has this issue occurred before?

Previous Issue

Root cause investigation required?

Implementation Action?

Review

Corrective/Preventative Action Completed? First choiceSecond choiceThird choice

Date of Completion

Notes

	Attachment
	Attachment

Mark this checkbox if you'd like to type HTML tags Click to enter a label Type your label here Click to add a hint Type your hint here Click to enter text Type your text here Remove File

true

Add Language