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Clinical Expert Panel - Application form

Personal information

Experience in rural or remote practice? *

Are you currently engaged in clinical practice? *

Do you identify as Aboriginal or Torres Strait Islander? *

Are you culturally and linguistically diverse? *

Professional information

Any restrictions on registration or practice? *

Any serious past complaints or being investigated? *

Any significant past or pending litigation? *

Previous experience with investigations

Please note that if you have not had any experience in participating on an investigation team your application will not be supported. We recommend that you contact your local Director of Clinical Governance for advice on opportunities to gain experience in investigations.

Have you been a member of a Serious Adverse Event Review (SAER) Team? (Previously known as RCA)

Do you participate in local SAER investigations or internal reviews?

Have you received SAER training conducted by the CEC?

Have you participated in other high-level reviews or investigations?

Have you undertaken any other training that would assist you in undertaking a review or investigation?

Have you completed any relevant studies where the principles of investigations were included in the course?

Reason for application

Referees

We pay respect to the Traditional Custodians and First Peoples of NSW, and acknowledge their continued connection to their country and culture.