Ministry Camps

Ministry Staff Reference Form

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CYC Waihola would like to thank-you for agreeing to complete this reference form for the applicant – we really appreciate your time and responses.

The responses you make are made in confidence to the CYC office only and are not shown to the applicant unless you agree that we may discuss your responses with them. With this in mind we do ask that you are as honest as possible in your answers.
If you are a member of the applicant’s immediate family (i.e. a parent, child or spouse) then unfortunately you cannot complete this reference for them.

Please Note

All reportable incidents must be reported.
All reported incidents are:
- used for trend analysis, future planning and reporting to the appropriate authorities as required.
- kept on file in the CYC Waihola office.
It is preferable that this form is completed within 24 hours of the incident occurring
All incidents on the Incident Severity Table that are level 3 and above will be reported on the National Incident Database (NID) and incidents level 6 and above are reported to Worksafe as well
The contents of form will be kept confidential to CYC Waihola management
- Only summarised details will be given discerningly by the Operations Manager to caregivers and outside agencies if requested

Please Note

All reportable incidents must be reported.
All reported incidents are:
- used for trend analysis, future planning and reporting to the appropriate authorities as required.
- kept on file in the CYC Waihola office.
It is preferable that this form is completed within 24 hours of the incident occurring
All incidents on the Incident Severity Table that are level 3 and above will be reported on the National Incident Database (NID) and incidents level 6 and above are reported to Worksafe as well
The contents of form will be kept confidential to CYC Waihola management
- Only summarised details will be given discerningly by the Operations Manager to caregivers and outside agencies if requested

Please Note

All reportable incidents must be reported.
All reported incidents are:
- used for trend analysis, future planning and reporting to the appropriate authorities as required.
- kept on file in the CYC Waihola office.
It is preferable that this form is completed within 24 hours of the incident occurring
All incidents on the Incident Severity Table that are level 3 and above will be reported on the National Incident Database (NID) and incidents level 6 and above are reported to Worksafe as well
The contents of form will be kept confidential to CYC Waihola management
- Only summarised details will be given discerningly by the Operations Manager to caregivers and outside agencies if requested

Please Note

This form is for falls and incidents not resulting in anything more than a minimal injury. Any fall or incident that was a cause for concern or could have been “more serious if not for the grace of God” should have a Horse Incident Reporting Form completed
Please make a comment on any falls or incidents that were caused by anything that could have been prevented or caused by another horse/rider.

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All reportable incidents must be reported.
All reported incidents are:
- used for trend analysis, future planning and reporting to the appropriate authorities as required.
- kept on file in the CYC Waihola office.
It is preferable that this form is completed within 24 hours of the incident occurring where possible.
All incidents on the Incident Severity Table that are level 3 and above will be reported on the National Incident Database (NID) and incidents level 6 and above are reported to Worksafe as well
The contents of form will be kept confidential to CYC Waihola management
- Only summarised details will be given discerningly by the Operations Manager to caregivers and outside agencies if requested
Please make a comment on any falls or incidents that were caused by anything that could have been prevented or caused by another horse/rider.