/ TRAINING
REQUEST FORM
Date
See page 2 for training choices
Name of the organisation
Training location (address, room number)?
On which date do you wish to receive training? / Second choice
of date
At what time of the day (morning, afternoon or evening) do you wish to receive the training? / Morning
Afternoon
Evening / Number of expected participants / Users’ Committee
In-patients’ Committee
Others
Time slot desired / From / To / Number of participating committees
Do you have a computer with Microsoft PowerPoint software? / Yes No / Do you have a projector (canon) for PowerPoint presentations? / Yes No
Is the room where the training will take place equipped with a projection screen (or a white board)? / Yes No / Do you have an extension cord to connect the electrical equipment? / Yes No
What are the concerns regarding the operation of your committee?
Name of person responsible for requesting the training
Email address of person responsible
Telephone / Cell
Important: We need to be able to reach the person responsible at all times
in case of cancellation
The RPCU requests a delay of 30 days from the date of application for the organization of the training,
the choice of trainer and for planning the day’s events.
Please return the questionnaire to the RPCU by email (attached document),
by fax or by regular mail to the attention of :
Regroupement provincial des comités des usagers
Recherche, développement et formation (Research, Development and Training)
C.P. 60563, succursale Sainte-Catherine Est, Montréal (Québec) H1V 3T8
Telephone: 514 436-3744 / Fax : 514 439-1658
Email:
Please indicate your choice of training
Basic training (4 hours) / FOB
MALTRAITANCE (offered in French only)
Formation sur la maltraitance envers les personnes aînées (french) / FOB
Conférence sur la maltraitance envers les personnes aînées (french) / CMA
SPECIALIZED TRAINING (PACKAGES)
Note: the following courses are offered in French only
Le plan d’action (4hours) / FPA
Les différences dans l’évaluation de la satisfaction des usagers réalisée par l’agrément et celle par le comité des usagers (3hours) / FES
L’interprétation des résultats des sondages de l’agrément auprès des usagers(3hours) / FSA
Le choix des sujets d’évaluation auprès des usagers (3hours) / FSE
Comment se servir d’un commentaire pour le bien-être collectif des usagers que l’on représente(3hours) / FCU
Les étapes d’une évaluation de la satisfaction auprès des usagers ou des résidents(3hours) / FEE
La place et le rôle du comité des usagers en matière de qualité et de gestion des risques(3hours) / FGR
Important: Please attach this page to the first page
when returning the questionnaire