Instructions: Complete this form to request support from QCOSS for Human Services Quality Framework (HSQF) implementation. Support is available to organisations funded under the Community Services and Child and Family funding streams. Organisations can self-refer or be referred by a Department of Communities, Child Safety and Disability Services (DCCSDS) contract manager. Contract managers must discuss the referral with each organisation prior to submitting a completed referral form to QCOSS.

Email completed referral forms to QCOSS on .

Organisation details:

Organisation: / Click here to enter text. /
Funded Service Type: / ☐Child Protection – Placement
☐Child Protection – Support
☐Young People
☐Community
☐Domestic & Family Violence
☐Families
☐Individuals
☐Older People
☐OtherClick here to enter text. / HSQF in-scope:
☐Yes
☐No
HSQF Audit Type:
☐External certification
☐Self-Assessment
☐Other Evidence
Address: Click here to enter text.
Contact person: Click here to enter text.
Contact email: Click here to enter text. / Contact phone number: Click here to enter text.

Type of Referral:

☐ DCCSDS HSQFTeam
☐ DCCSDS Regional Contract Management
☐ Organisation (self-referral)
DCCSDS Region: Click here to enter text. / Date of Referral: Click here to enter text.
Contact Manager: Click here to enter text. / Contact details: Click here to enter text.

1 /11 August 2015Quality Support Referral Form

Reason for Referral:

Reason for Referral:
Describe assistance required and particular areas of need.
Click here to enter text.
Organisational capacity:
Describe the organisation’s existing capacity for implementation i.e. human resources and experience.
Click here to enter text.

QCOSS Use Only:

Previous contact with the organisation (including other branches/head office): / ☐Yes
☐No
Details of services provided::
Click here to enter text.
Application Decision:
☐ Accepted
☐ Not Accepted
Has referring DCCSDS contract manager been advised the referral has been received and accepted/not accepted?
☐Yes
☐No
Date: Click here to enter text.
Comments:Click here to enter text.
Follow up Action: Click here to enter text.

1 /11 August 2015Quality Support Referral Form