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Department of Premier and Cabinet

Example of a Consistency Checklist

Criteria

Score

Can explain reason for the restriction:

  • John can over fill his mouth and eat too quickly which becomes a choking risk. He can eat raw meat stored in the fridge
 

Can explain steps in the protocol:

  • John can come and grab a worker’s hand and point them towards the cupboard if he wants something to eat.
 
  • He sometimes uses communication cards to indicate he wants some food
 
  • Staff are to respond immediately to John if he requests access to the fridge or cupboard
 
  • If staff can’t respond straight away, then negotiate with John about when they can respond
 
  • Other residents’ requests for food or drinks should also be responded to as above.
 


Initials of staff member:-  _______

DATE:     _____________

Score Achieved:

Score Possible:

Percentage of Score Achieved to Score Possible:  

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