DRAFT SUBSTANCE ABUSE POLICY | YOUR INPUT IS REQUIRED

Here follows a copy of the SABC’s proposed Substance Abuse Policy. We require your input, either by email to headoffice@bemawu.org.za or by commenting on this page.

We prefer your comments, as other members will have the benefit of seeing it, and build on those comments. If you do not wish to have your comment published, please state so at the end of your submission/comment.

We think this Policy is overly legalistic, too complicated and formalistic  and  drafted by a consultant who has nothing else to do and must justify his salary.

A copy of the policy can be downloaded here SABC Substance Abuse policy_20160921_FINAL_Cover.

PLEASE RESPOND AND PROVIDE INPUT – THIS POLICY WILL APPLY TO YOU!

____________________________________________________________________________________________________________________________

SABC POLICY No.
HR/006/16/N
 
POLICY TITLE: SABC SUBSTANCE ABUSE POLICY
CUSTODIAN AREA: ORGANISATIONAL DEVELOPMENT (HR)
PREPARED BY: NOMUSA KWEYAMA
DATE APPROVED:
EFFECTIVE DATE:
APPROVED BY:

Table of Contents

  1. Preamble ……………………………………………………………… 3
  2. Purpose of this Policy ……………………………………………… 3
  3. Definition and concepts ……………………………………………. 3 –  4
  4. Scope and application ……………………………………………… 5           
  5. Legislative framework and policy mandate……………………… 5
  6. Guiding Principles……………………………………………………. 6 – 7
  7. Objectives……………………….…………………………………….. 7
  8. Signs and Observations…………………………………….………. 7 – 8
  9. Intervention…………………………………………………………….  8
  10. Alcohol and Drug Awareness………………………………………   8
  11. Policy Coordination……………………………………………………   9
  12. Consuming alcohol at work related functions…………………… 9
  13. Selling alcohol or drugs on company properties……………….. 9
  14. Referral Procedure……………………………………………………. 10 – 11
  15. Drug testing……………………………………………………………. 11 – 13
  16. Referral outcome……………………………………………………… 13
  17. Roles and Responsibilities………………………………………….. 14 – 16
  18. Deviation……………………………………………………………….. 16
  19. Policy Review…. …………………………………………………… 17
  20. Addendums/Annexures/Agreements…………………………… 18 – 20

             

 1.  PREAMBLE

The South African Broadcast Corporation (SABC) is committed to managing substance abuse in the workplace. In doing so, the company aims to create a workplace free of substances that offers healthy working conditions for all. The SABC recognises that substance abuse constitutes a severe risk to the affected individual and the company. Substance abuse has been demonstrated to negatively affect a person’s physical, psychological and social well-being and often negatively impacts on the entire social network surrounding the individual. In a work context the risk extends far beyond the individual with an increased occurrence of absenteeism, presenteeism, potential incapacity and an increased risk for fraud. Managing drug and substance abuse then becomes paramount in the containment of behavioural and organisational risks and is treated as a primary concern.

 

2.  PURPOSE

 2.1       This policy provides a framework for ensuring a healthy, safe and conducive workplace that addresses the abuse of alcohol and drugs.

2.2       To maintain the performance standards and reputation of the corporation, not only of business viability but also of the job security of employees.

2.3    To provide and maintain a working environment that is safe and without risk to the health and welfare of employees.

 

3.  DEFINITION OF CONCEPTS

 

TERMS                     DESCRIPTION
Substance Abuse Substance abuse means the consumption of intoxicating substances by an employee which detrimentally affects his or her performance or ability to do the work and/or relationships at work. It includes both intoxication and impairment at work.

Substances include: (inter alia alcohol, solvents, prescription drugs such as analgesics, cough syrups, diet preparations and stimulants, which may or may not be taken with medical supervision, as well as illicit drugs, such as marijuana, cocaine, ecstasy, tik etc.).

Substance abuse occurs when increasing amounts of a drug required to achieve the same effect, or if using a substance impairs or jeopardises the health or safety of yourself or others.

Illegal Substance Any substance considered or defined as “illegal” or “prohibited” in terms of applicable legislation.
Immediate Families For the purpose of the Employee Assistance Programme, ‘immediate family’ covers the employee’s spouse, a partner, and any other family member who lives with the employee and who is dependent on the employee.
Impairment A mental or physical condition or the abuse of or dependence on chemical substances which has adversely affected a person’s competence, attitude, judgement and performance.
Employee Health & Wellness Programme A programme designed to promote the health and wellness of all employees with the aim of creating a conducive and safe working environment that enables employees to function optimally.
Employee Assistance Program (EAP) A programme that is intended to help employees deal with personal problems that might adversely impact their job performance, health, and well-being.
Sober/ Sobriety A state of being sober, not intoxicated or impaired.

 

4.  SCOPE OF APPLICATION

4.1        This policy will apply to all employees at the work place and official functions of the  SABC on or off the premises whilst on duty.

4.2        All employees at the SABC are expected to report to work sober and capable to perform duties safely.

4.3        The SABC strictly prohibits the abuse and/or possession of alcohol and drugs on and off its premises whilst on duty. Any employee found to be in contradiction of this instruction will be subjected to disciplinary action in terms of the SABC’s Disciplinary Code and Procedure.

 

5.  LEGISLATIVE, REGULATORY AND POLICY FRAMEWORK

 According to the Occupational Health and Safety Act No. 130 of 1993, employers are required to provide and maintain a working environment that is safe and without risk to the health or welfare of its employees. Employees who are affected by alcohol, drugs and other potentially harmful substances in the workplace are a risk to themselves and others around them. It’s therefore important for SABC to have a policy that governs safe working environment and ensures employee wellness. This policy is guided by the following legislation:

  • Compensation for Occupational Injuries and Diseases Act (COID Act) No.130 of 1993
  • The National Health Act No. 61 of 2003
  • The Constitution of the Republic of SA, 1996
  • The Labour Relations Act No.66 of 1995
  • Employment Equity Act 55 of 1998
  • Basic Conditions of Employment Act No 11 of 2002
  • SABC Draft Employee Health and Wellness Policy 2015

 

  • GUIDING PRINCIPLES

 

  1. Confidentiality: The Corporation will treat each instance of substance abuse with the greatest possible confidentiality. Personal information about the person abusing the substances will not be shared with a third party without the expressed consent of the employee concerned. Confidentiality may however be breached in an instance where there is a risk to the person abusing the substance, other individuals or the company.

 

  1. Rights: An employee being identified with an alcohol and/or drug abuse related problem will be afforded the same protection and employment rights as other employees suffering from ill-health related problems. In addition, no employee will be formally referred without a signed consent.

 

  1. Professionalism: All parties must act professionally during the process of assisting the employee.

 

  1. Training: To encourage a healthy and responsible approach to managing alcohol and/or drug abuse in the workplace. This can be addressed through the provision of substance abuse awareness and education opportunities to employees.

 

  1. Responsibility: The employer has an obligation and duty to make sure that all

intoxicated employees do not enter the workplace which is in line with observing Occupational Health and Safety Act No 130 of 1993.

 

7.     OBJECTIVES

 

  • Raise awareness on the risk of alcohol and drug abuse related problems.
  • Promote the health and wellbeing of employees.
  • Prevent the occurrence of injuries on duty caused by the effect of intoxicating alcohol, drugs and related substances.
  • Ensure that employees do not have their health and safety compromised by another person working under the influence of drugs and/or alcohol at our workplaces.
  • Ensure the early identification of employees suffering from behavioural problems leading to the misuse of intoxicating substances or who suffer from addiction to or dependence on alcohol, drugs or related substances by providing awareness and education programmes.
  • Provide assistance with rehabilitation of addicted/dependent employees and subsequent return to work.

 

8.  SIGNS AND OBSERVATIONS

  • The signs and observations of possible substance abuse related behaviours are referenced below.
  • One may not confirm a substance abuse problem on the basis of one observation. The following signs may be considered as indicators that should be assessed in combination to others over a period of time.
  • It is important to note that the following signs are not for the purposes of diagnosing but they may be considered to enhance substance abuse awareness.
  • Smell of alcohol;
  • Slurred speech and uncoordinated movements;
  • Erratic work performance;
  • Bloodshot eyes;
  • Aggressive and confrontational behaviour;
  • Unusual behaviour;
  • Difficulty maintaining a coherent conversation;
  • Unexplained episodes of falling asleep;
  • Unexplained periods of exhilaration and euphoria;
  • Impaired judgement;
  • Absenteeism;
  • Late coming;
  • Accidents and unusual incidents;
  • Fluctuating work performance;
  • Fluctuation in concentration and energy;
  • Unpredictable mood changes;
  • Poor co-operation with co-employees;
  • Excessive sweating;
  • Unreliability;
  • Aggression/Irritability;
  • Confusion or drowsiness;

 

9.     INTERVENTION

 

  • The employees with alcohol and/or drug abuse problem are encouraged to seek assistance on a voluntary basis and to report to the SABC’s Employee Wellness or Human Resources or liaise with line management; Early detection of individuals with alcohol and/or drug problems is a shared responsibility of all employees and management;
  • It is recognised that this is a complex and difficult issue. Supervisors/line managers will be trained and supported to recognise problems and deal with substance abuse issues timeously and effectively;
  • The decision to seek assistance, and accept professional intervention will be at the discretion and responsibility of the concerned employee;

 

10.  ALCOHOL AND DRUG AWARENESS

 The SABC will encourage a healthy and sensible approach to alcohol and/or drug abuse by providing education/training opportunities to employees in order to:

  • · Increase the awareness of responsible drinking and early signs of alcohol
  •  and/or drug dependency;
  • · Increase knowledge of the risks associated with alcohol and/or drug abuse;

The above will be achieved through:

  • ·       Specific life skills projects e.g. alcohol awareness campaigns in the work place;
  • ·       Provision of appropriate information; and
  • ·       Modules on education and staff development courses.

 

11.  POLICY CO-ORDINATION

  • The successful implementation and maintenance of this policy is the responsibility of all employees, line management and Human Resources as the custodian of the policy as well as union representatives;
  • All parties responsible parties should:
    • Be familiar with the policy provisions and procedures;
    • Provide information on the policy and encouraging employees who may have an alcohol and/or drug abuse related problems to seek assistance voluntarily;
    • Assist the employee and monitoring job performance when he/she remain and/or returns to work;
    • Have up to date information on alcohol and drug abuse advice and treatment possibilities.

 

  1. CONSUMING ALCOHOL AT WORK/ WORK-RELATED FUNCTIONS

Where alcohol is being served at work (or work-related) function, whether at the workplace or official functions of SABC, irrespective of the purpose, whether during normal office hours or not, it’s expected that all staff attending such a function exercise caution and discretion, and not indulge to the extent that their behaviour could be considered to reflect poorly on the company. Abuse in this regard will be dealt with accordingly.

13.  SELLING ALCOHOL OR DRUGS ON COMPANY PREMISES

    • The selling of alcohol and or drugs on SABC premises is strictly prohibited.
    • If an employee is caught manufacturing, selling or distributing, in possession of, using or under the influence of alcohol or illicit drugs on the property or in the course of their work, they will be suspended and the company will take disciplinary action according to its disciplinary code and procedure.

 

14.  REFERRAL PROCEDURES

  • Self-Referral

 

  • If an employee declares that he/she has a substance dependence problem to their respective manager/supervisor or Human Resources or directly to Employee Wellness, such employee must be encouraged to seek help or undergo an Employee Assistance Programme (EAP).

 

  • An employee can make use of telephonic self-referral, call back facility or make an appointment without the knowledge or participation of the manager/supervisor, HR and Employee Wellness. If the attendance of therapeutic sessions overlaps with the working hours, it recommended that there should a mutual agreement between employee and the supervisor should be in place on based operational requirements.

 

  • An employee who as a result of self-referral, is subjected to extensive treatment plan (e.g. Hospitalisation) that requires absence from work, the employee will be deemed absent due to ill-health and will be expected to utilise sick leave as per leave policy.

 

  • Assisted/ Formal Referral

 

  • An employee who has been identified to have a substance abuse problem should be referred to EAP through an assisted or formal referral process, for further assessment and support in order to ensure that decisions about treatment are made by clinically qualified persons.

 

  • The referral to the programme must ensure that employees and their family members have access to professional and confidential counselling services.

 

  • The counselling services will be provided by professional psychologists and counsellors. An employee will be requested to consent to the assisted/ formal referral process.

 

  • If an employee refuses to accept that they have a problem and refuses internal help by the organisation, they should be informed that the standard disciplinary procedures will be followed, which may lead to dismissal.

 

  • Where it is clear that an employee’s performance, attendance or relationship at work is affected because of substance abuse, such employee shall be given the opportunity to undergo rehabilitation, which may include inpatient or outpatient treatment.

 

  • Once an employee’s normal sick leave is depleted leave policy clauses will apply.

 

  • If the employee needs time off work for rehabilitation as an inpatient, the employer may grant sick leave based on availability as per the sick leave cycle.

 

  • Any cost incurred for the inpatient rehabilitation would be from the employee’s medical aid.

 

  1. DRUG TESTING
  • Breathalyser Testing (consent of the employee must be obtained in writing where possible).

 

  • If an employee arrives at work intoxicated and it’s clear that the observations and signs listed under clause 8.3 have been identified and that the employee cannot perform their duties, then the employee can be asked to undergo breathalyser test.

 

  • If an employee refuses to accept that they have a problem and refuses internal help by the organisation, they should be informed that the normal disciplinary procedures will be followed, which may lead to dismissal.

 

  • If the employee deems it necessary to have a representative during the drug testing procedure, he/ she is entitled to invite a representative.

 

  • A reliable test must be used and will be obtained from the Wellness Centres or Human Resource Offices or Security Control offices.

 

  • Administrators of breathalyser tests will be trained on the use the device and interpretation of the results. This also includes a prior explanation to the employees that will undergo a breathalyser test.

 

  • A breathalyser test supports the signs of intoxication and establishes whether the employee has consumed alcohol. The results of the test must be recorded on a form (Annexure A).

 

  • The administrators of breathalyser tests must also make notes of the employee’s general appearance and attitude together with a witness (Annexure A).

 

  • An employee who is intoxicated and evidence obtained that the results are positive should be accompanied home immediately after the test confirmation.

 

  • Upon the employee’s return to work, an assisted/ formal referral process will be facilitated accordingly as per clause 14.2.

 

  • Blood and Urine Testing
    • SABC reserves the right to test for substance abuse with a blood/ urine test by referring the employee to a third party with their consent.

 

  • In instances where breathalyser test is unable to detect the drug on the system, the employee will be requested to undergo blood and urine testing.

 

  • The drug and testing will be done through medical professionals such as Occupational Health Nurses (when available) or alternatively an employee will be referred to the nearest hospital or laboratory to undertake the test.

 

  • Upon receipt of the results, they will be recorded in an appropriate form (Annexure A).

 

  • The cost for testing will be accepted by the employer.

 

  1. REFERRAL OUTCOMES

 

  • Employees, who have successfully completed the rehabilitation program, will undergo fitness for work assessment on the first day of return to work and will be monitored by Employee Wellness Centre for a period of 3 months. If there is no relapse for a period of one year, that will deemed as a sustained evidence of the successful referral outcome.

 

  • If the employee relapses after the inpatient rehabilitation treatment, she/he will be granted a second opportunity through a referral process. Note should be taken that the referral process will not be unlimited therefore an employee will be subjected to a maximum of two referrals in one year. Should the employee’s rehabilitation be unsuccessful and continues impact on productivity and work performance, she/he will be further subjected to incapacity process/ misconduct where it’s applicable.

 

  • Where the substance abuse problem persists and continues has an impact on operational requirements, as a last measure the issue may be addressed in terms of the SABC’s Policy on Incapacity or the Disciplinary Code and Procedure, whichever is applicable.

 

  • Where an employee’s work related performance or behaviour remains unsatisfactorily despite availability of professional services, such matters will be addressed in terms of the provisions of the Policy on Incapacity.

 

  1. ROLES AND RESPONSIBILITIES
  • LINE MANAGER SHALL:
    • Identify work performance or behaviour indicator of possible alcohol and/or drug related problem.
    • Discuss the identified problem with the employee concerned and make him/her aware of the availability of support services (Human Resources, Employee Wellness unit as well as the Employee Assistance Program). The manager should ensure that an employee who fails to disclose a problem understand the consequences of such non-disclosure.
    • The manager should initiate a formal referral after the discussion with the concerned employee.
    • Only deal with work related issues and not endeavour to diagnose any possible personal problems unless the employee elects to disclose any such problem/s.
    • It is the responsibility of manager/supervisor to maintain and adhere to confidentiality.
    • Keep factual and accurate written records of incidents and interaction with the employee. These records should be kept in a “confidential folder” in the employee file and will be filed centrally with the Human Resources Shared Services.
    • Monitor daily progress of the employee post rehabilitation. Where relapses are noted, management shall report to Employee Wellness and Human Resources.

17.2.   HUMAN RESOURCES SHALL:

  • Ensure that any employee who seeks assistance will be treated with     dignity,                         discretion and in confidence.
  • Facilitate wellness referrals to guide employees who are dealing with substance use/ abuse issues
  • Support employees that require special leave to attend rehabilitation.
  • Assist the manager with monitoring employee’s performance post rehabilitation.
  • Be trained to effectively administer alcohol testing and to record the results in the appropriate form.

 

  • EMPLOYEES SHALL:
    • Report for duty free of the effects of alcohol and/or other drugs.
    • Remain free from the effects of alcohol and/or other drugs at all times while at work.
    • Behave responsibly in relation to the consumption of alcohol when attending a work-sponsored function.
    • Inform the line manager if taking or intending to take any drugs, prescribed or otherwise, that may affect the ability to work safely. In the first instance, the employee should approach their immediate supervisor who will inform them of the appropriate person to whom they should report.  The SABC will ensure that confidentiality in relation to any such disclosures is respected at all times.
    • Seek voluntary assistance, agree to referral and/or accept recommended professional intervention.
    • Sign a consent form to enable a formal referral process to occur.
    • Co-operate with the drug testing procedure.
    • Comply with the treatment plan.
    • Request special leave from the manager if the leave is depleted.

 

  • EMPLOYEE WELLNESS SHALL:
    • Facilitate a formal referral process and ensure that the employee receive professional help immediately.
    • Facilitate hospitalisation if required.
    • Cover the costs of blood and urine testing and ensure that drug testing equipment’s are available in all SABC offices.
    • Support special leave application based on the medical reports and employee compliance to treatment.
    • Monitor the employee for the period of 3 months post rehabilitation.
    • Facilitate the training of managers, Human Resources and Security personnel.
    • Organise and encourage employees to attend drug and alcohol awareness campaigns.
    • Ensure that relevant articles and educational programs are in place.

 

  • EXECUTIVES SHALL:
    • Encourage and support the policy in order to proactively manage and maintain brand integrity.
    • Approve special leave as per the provision in the leave policy.

 

  • SECURITY SHALL:
    • Apply security procedures to ensure that employees do not bring drugs and alcohol to the work environment.
    • Be trained to effectively administer alcohol testing and to record the results in the appropriate form.

 

18.          DEVIATIONS

  • No deviations from this policy will be allowed.

 

  1. POLICY REVIEW
    • This policy will be reviewed on a two-year basis

 

  1. POLICY MONITORING
Monitoring = continuous.

POLICY REVIEW HISTORY

 

Date

 

01 July 2016

 

Reviewed by

 

GM: Group OD

 

Nature of change

 

Updates

     

 

 

 

 

 

  1. ADDENDUMS AND ANNEXURES

ANNEXURE A: FORM FOR TEST RECORDINGS

 

ALCOHOL/ DRUG ABUSE SIGNS, OBSERVATIONS AND TESTING RECORD

Name of employee  
Employee no: Division  
Date  
Line manager  

 

DETAILS OF SIGNS AND OBSERVATIONS: (circle the appropriate one)

Clear Bloodshot Pupils Dilated

 

  1. Eyes Appearance

 

  1. Coordination Reaction:
Steady Unsteady Unable to walk

Walk:

 

Normal Shaking Tremors

Hand movement:

 

  1. Speech / Behaviour / Smell Speech:
Normal Talkative

Speech

 

Aggressive Defensive Normal

 

Behaviour

 

 

Normal Smelling alcohol

Smell

 

  1. Breathalyser / Drug testing (Blood or Urine testing)
  2. Employee consent (Annexure B):
Type of test:
Readings:
Time taken:

 

 

Signature of line manager: _________________________

 

Test takers signature: _____________________________

 

 

 

 

 

 

 

 

 

 

ANNEXURE B: CONSENT FORM

 

MANAGERIAL REFERRAL: FORMAL REFERRAL FORM

 

It is important for the formal referral forms to be filled out in as much detail as possible. This enables all parties involved to be able to provide the necessary feedback and support required in order to ensure the best possible outcome to the process. Please note all sections of the form are compulsory to complete in order for the referral to take place.

 

ICAS case number  

 

Section A: To be completed by the Referrer (Employee to initial each page).

 

Referrer’s details Employee’s details
Name : Name:
ID number: ID number:
Position: Position:

 

Company: Site & Division:

 

Site & Division:

 

Cell number:
Cell number:

 

Work number:

 

Work number:

 

Email/Fax:

 

Email: Age:

 

Fax: Length of service:

 

Reason for referral:

 

Impact of the problem on workplace functioning (include factors such as key performance indicators impacted upon, attendance, relationships at work, and ability to manage key aspects of job role):

 

How does the employee explain his or her problem?

Is there any other information that, in your opinion, is contextually relevant to this case (including your expectations)?

 

Is there a current disciplinary or incapacity process in place? If so, please state which and the reason?

Section B: The Identification of Impaired Work Performance. To be completed by the referrer

 

CATEGORY & CRITERIA

Mark with ‘X’  

CATEGORY & CRITERIA

Mark with ‘X’
ABSENCE FROM WORK   SUBSTANCE USE/MISUSE/ABUSE  
Excessive sick leave Smelling of alcohol during working hours
Regular absence on Mondays and after ‘pay-days’ Being under the influence of substances during working hours
Above average absence due to vague ailments such as colds Being in conflict with the law because of driving a vehicle drunk
Unauthorised leave Positive breathalyser
Strange and unsatisfactory excuses for absence Disclosure of substance abuse issue by employee
Vague or frequent requests to leave early GENERAL INDICATORS OF DECREASED EFFICIENCY
ABSENCE WHILE AT WORK Struggling to concentrate
Continual absence from post Working in fits and starts
Arriving late for work, taking long meal breaks Difficulty in remembering instructions, details and own mistakes
Sleeping on duty Finding it increasingly difficult to carry out complicated instructions
ACCIDENT RECORD Not meeting deadlines
Accidents on duty High frequency of mistakes
Accidents outside working hours that impact on work performance Complaints from others regarding  services rendered by the person
Involvement of other employees in accidents Poor judgement and decision-making
Near-miss incidents Wasting of time and/or material
LEGAL PROBLEMS Performance standards consistently not met
Any legal related issues including court proceedings Unacceptable excuses for poor work performance
GENERAL APPEARANCE AND BEHAVIOUR POOR INTERPERSONAL RELATIONS WITH EMPLOYEES
Perceived abnormal reactions to normal circumstances Behaviour that elicits an unfavourable reaction from others
Abnormal behaviour Sudden mood changes
Complaints by fellow-workers regarding the person’s conduct Complications as a result of borrowing money from fellow workers
Risk to self or other/s Over-reaction to real or imagined criticism
Noticeable decline in self-hygiene and/or appearance (including workstation) Involvement in conflicts or fighting with fellow-workers
Aggressive behaviour for no apparent reason Involvement in conflicts or fighting with supervisor/management
Avoidance of fellow-workers (detachment) Unwarranted grievances
Please provide details or examples of the incident indicated above including dates where possible:

 

Section C: To be completed by the Employee

Please note: The formal referral process is a VOLUNTARY process.

The process: Upon signed receipt of these formal referral forms to your EAP, you will be referred for face-to-face counselling according to your preferences listed below. Your assigned therapist will contact you to set up an appointment. After your first session, the therapist will provide us with feedback on the assessment session, and in turn your referrer will be provided with work related feedback. Thereafter interim feedback is sought from the affiliate and your referrer, and interim feedback is provided to your referrer regarding progress made and any further recommendations are discussed at this stage. Upon completion of the face-to-face session’s written feedback is provided to the referrer in a summary report covering the reason for referral, key findings, and workplace recommendations. Personal information that does not relate to your work will not be disclosed.

 

 

1.       Consent to participate in formal referral process and for relevant feedback to be given to my referrer:

 

YES NO

 

Confirmation that you have received a copy of these formal referral forms:

 

YES NO

 

 

Employee’s name:_______________________________ Signature: ______________________Date:_______________

 

 

2.       Consent to be referred for face-to-face counselling- COMPULSORY to complete

 

I agree to be referred for face-to-face counselling, as part of the formal referral process, according to:

 

Preferred language for counselling:  
Preference areas (suburbs) for counselling

(Compulsory to complete and in order of preference. Please indicate onsite clinic if available):

1.
2.

 

3.
Special considerations (e.g. wheelchair access, using public transport, etc.):  

Please note that ICAS utilises SMS’s to the employee during the case management process.

 

 

Employee’s name:_______________________________ Signature: ______________________Date:_______________

 

 

3.       Consent to feedback to co-referrer (Optional)

 

I agree to relevant feedback being given to the person specified below as the co-referrer, in addition to my direct referrer:

 

Name: Designation:
Email address:

 

 

Employee’s name:_______________________________ Signature: ______________________Date:_______________

 

 

 

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