Common use of WORKING CONDITIONS/CONTRIBUTING FACTORS Clause in Contracts

WORKING CONDITIONS/CONTRIBUTING FACTORS. In order to effectively resolve workload issues, please provide details about the working conditions at the time of occurrence by providing the following information: # of scheduled staff  RPN  RN  Unit Clerk  Service Support # of staff working  RPN  RN  Unit Clerk  Service Support # of agency staff  Yes How many?  No # of RPNs on overtime  Yes How many?  No If there was a shortage of staff at the time of the occurrence (including support staff), please check one or all of the following that apply:  Absence/Emergency leave  Sick call(s)  Vacancies Please check off the factor(s) you believe contributed to the workload issue:  Change in patient acuity. Provide details:  Number of beds. Provide details:  Number of Admissions. Provide details:  Number of Discharges. Provide details:  Other. Please specify and provide details:

WORKING CONDITIONS/CONTRIBUTING FACTORS. In order to effectively resolve workload issues, please provide details about the working conditions at the time of occurrence by providing the following information: # of scheduled staff  RPN  RN  Unit Clerk  Service Support # of staff working  RPN  RN  Unit Clerk  Service Support # of agency staff  Yes How many?  No # of RPNs on overtime  Yes How many?  No If there was a shortage of staff at the time of the occurrence (including support staff), please check one or all of the following that apply:  Absence/Emergency leave  leave Sick call(s)  Vacancies Please check off the factor(s) you believe contributed to the workload issue:  Change in patient acuity. Provide details:  Number of beds. Provide details:  Number of Admissions. Provide details:  Number of Discharges. Provide details:  Other. Please specify and provide details:

WORKING CONDITIONS/CONTRIBUTING FACTORS. In order to effectively resolve workload issues, please provide details about the working conditions at the time of occurrence by providing the following information: # of scheduled staff  □ RPN  □ RN  Support □ Unit Clerk  □ Service Support # of staff working  □ RPN  □ RN  □ Unit Clerk  □ Service Support # of agency staff  □ Yes How many?  □ No # of RPNs on overtime  □ Yes How many?  □ No If there was a shortage of staff at the time of the occurrence (including support staff), please check one or all of the following that apply:  □ Absence/Emergency leave  □ Sick call(s)  □ Vacancies Please check off the factor(s) you believe contributed to the workload issue:  □ Change in patient acuity. Provide details:  □ Number of beds. Provide details:  □ Number of Admissions. Provide details:  □ Number of Discharges. Provide details:  □ Other. Please specify and provide details:

WORKING CONDITIONS/CONTRIBUTING FACTORS. In order to effectively resolve workload issues, please provide details about the working conditions at the time of occurrence by providing the following information: # of scheduled staff  □ RPN  □ RN  □ Unit Clerk  □ Service Support # of staff working  □ RPN  □ RN  □ Unit Clerk  □ Service Support # of agency staff  □ Yes How many?  □ No # of RPNs on overtime  □ Yes How many?  □ No If there was a shortage of staff at the time of the occurrence (including support staff), please check one or all of the following that apply:  □ Absence/Emergency leave  □ Sick call(s)  □ Vacancies Please check off the factor(s) you believe contributed to the workload issue:  □ Change in patient acuity. Provide details:  □ Number of beds. Provide details:  □ Number of Admissions. Provide details:  □ Number of Discharges. Provide details:  □ Other. Please specify and provide details: