QIC Review Evaluation Form

tewanaQIC REVIEW EVALUATION FORM

This form is to be completed following a QIC accreditation review by the CEO or representative of the service undertaking a QIC review. A similar questionnaire will also be completed by the review team.
This form must be returned to Te Wana with the sign-off of the Quality Workplan. The information contained in the questionnaires will be forwarded to the QIC Secretariat and will contribute to Te Wana and QIC's own quality improvement cycle.

Name
Position
Name of Service
Address
Licenced Provider
Standards Used
Date Review Completed

YOUR LICENCED PROVIDER
Any comments regarding YOUR LICENSED PROVIDER?
THE STANDARDS
Any comments regarding THE STANDARDS?