Create Workload

Select Your Sector

Your Employer

Your Full Name

Your Email address

Your Telephone Number

Tags

At the time the workload issue occurred, I/we discussed the issue within unit to resolve the concern using current resources.

Name of the Union Representative/Steward Spoken to

Date of notification:

Time of notification:

Failing resolution at the time of occurrence, using established lines of communication, I/we sought immediate assistance from an individual(s) identified by the Employer (who could be within the bargaining unit) who has responsibility for timely resolution of workload issues.

Signature

Date of Occurence

Time of Occurence

Enter the email address of the manager/nurse leader who should receive this workload form

Department/Unit

Workplace/Site/Location

Was there a shortage of staff at the time of the occurrence?

Select your Occupation to tell us more about vacant classifications and/or absent classifications

Brief Description of Workload Concern:

Staffing Shortages (see section 2)

Resident/ Work Preparation Concerns

Resident/ Work Volume

Provide written details of the occurence with specifics for Resident/ Work Volume

Details of Admissions

Details of Discharges

Number of Admissions

Number of Discharge

Number of Transfers

Number of Isolation

Lack of Resources/Supply

Interdepartmental Challenges

Exceptional Resident Factors

Other

LTC Workload Review Form

Form Instructions

Your Information

SECTION 1: Initial Attempt

SECTION 2: Info(employer's email)

SECTION 3: Factors

SECTION 4: Solution