WACOSS |

1. Provider Name *

2. Contact Email *

This can be your own email address or your organisation's contact email address.

3. Program / Sub-Service Name *

A title that identifies the service - E.g. Homeless Accommodation - Coolabaroo Housing Service.

4. Service Location - Primary *

5. Service Location - Other

Please fill in this field if you have complex or multiple areas that this specific service covers

6. Current Service Status

Current status of the service. You can select multiple responses.

7. Please provide details for modified operation

If COVID-19 has forced the service to be modified, describe how - i.e. reduced number of beds available from X to Y due to isolation/social distancing requirements.

8. Is this a critical service? *

Any service working with people who are vulnerable and would not be able to meet their own needs (activities of daily living) without support, cannot meet their basic needs of food, shelter and safety and prevent people from escalating into emergency departments falls into a “critical service”. This includes those in residential and non-residential services, food security and financial counselling. This applies to: Aboriginal people who utilise community service supports, People who are homelessness includes couch surfing, People with severe and persistent mental health and drug and alcohol issues, Women and children escaping domestic violence, Seniors, Children in out of home care, People (adults and children) with disability, Residential services for all the above, Remote Communities, People experiencing poverty.

9. Is the service accepting referrals? *

10. If only accepting new clients in specific circumstances, please specify:

Expand on what the circumstances are for accepting client referrals.

11. What is the primary cohort serviced? *

This is to identify the primary group that the service targets and cross-reference into the Task Forces that have been set up to respond to vulnerable cohort needs.

12. What is the Secondary Cohort serviced?

Supplements above question for identifying complex cohort groups.

13. If other cohorts are serviced but not listed, provide details below:

Add in specific target groups that are not identified in the predefined lists of above questions.

14. How many frontline staff are currently deployed (FTE)? *

Current number of staff (FTE) deployed to identify changes from above question.

15. What is the minimum number (FTE) of frontline staff required to continue the service? *

What is the number of frontline staff (FTE) below which the service cannot continue to operate at all? If there are critical roles required for continued operation (e.g. clinical), what is the minimum number of those needed.

16. If client/consumer demand has changed, what is the estimated % change in demand from normal (use "-" before the number if less)? Leave blank if no change.

Identify if demand on the service is increasing or decreasing. Use an approximate % figure to indicate any increase or decrease in demand. E.g., -10 if demand has dropped off by 10%, 20 if demand has increased by 20%. Update as and when demand changes occur.

17. If any increase in demand is for services other that what is normally provided, what is the nature of the increase?

This is to help identify emerging demands that are not being met. Update as and when demand changes occur.

18. Are additional/supplementary staff required to maintain the service? If so, how many (FTE) and what skills are required? Leave blank if none required

Identify if additional or supplementary workforce resources are needed to maintain the service and meet demand.

19. If other areas of your organisation reduced or ceased operation, how many (FTE) staff are currently available for redeployment?

The number of staff whose normal roles have stopped and could be redeployed into other service areas if required and suitably qualified?

20. How is the service ordinarily delivered? *

21. How can this service be delivered in case of emergency (i.e. such as COVID-19)? *

22. How is the service currently being delivered (i.e. currently being in late stages of emergency response/early stages of recovery response to COVID-19)? *

23. If there is a change in how this service can be delivered, would this increase or decrease the normal number of (FTE) of frontline (client-facing) staff and if so by how many? Use "-" before the number if less. Leave blank if no change

Identify where staffing numbers would change if an alternative service model was adopted - for example, would remote delivery require more/less staff because their availability would be reduced/increased.

24. If the service provides accommodation, are there clients that could not be safely isolated due to COVID-19 & what would be their requirements?

For accommodation providers, identify f there are any client groups that could not be isolated safely so that possible alternatives for these groups might be sourced.

25. What is the most critical constraint for continuing service operation at a normal level? *

What is the biggest constraint that will cause the service to reduce, pause or cease operation. E.g., Accommodation becoming unavailable/unsuitable, No PPE for frontline staff, Unable to travel to service clients, No availability of qualified staff etc.

26. If above is "Specialised Equipment" or "Other", provide details below: *

Expand on the specific constraint to continuing service operations.

27. How many weeks can the service continue with current levels of the constraint identified in above question? *

Provide a timeframe for when the constraint identified above will start to impact unless stocks are maintained. E.g., with our current stock of PPE our service can operate for another 2 weeks.

28. If the service were to cease, how many clients might need to transition into the health care system? *

Some indication of how many individuals might need to transition to secondary or tertiary health care if this service was to cease.

29. What is/are the Primary Funding Source(s) for this service? *

You can select multiple. Required to map funding sources for service reliability/continuity.

30. Funding Security - how long is the service currently funded for? *

Helps build a timeline for contingency planning.

31. Is this service funded by Department of Communities? *

Helps determine source of funding.

32. Primary Contact Phone Number *

Main telephone number to contact the service.

33. Service Street Address (leave blank if confidential)

34. If it isn't already, can this service be included in ERConnect/WAConnect?

WAConnect (https://waconnect.org.au), formerly known as ERConnect, is an on-line map of the community services sector administered by WACOSS and will soon expand as WA Connect to include other non-emergency relief services. This information would be drawn from other questions in this form.

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