Pre-submission Checklist (optional)
Integrated Performance and Incentive Framework
PHO Minimum Requirements Self-Assessment
Pre-submission Checklist
November 2014
1
Pre-submission Checklist (optional)
Please submit the completed Self-Assessment Templates with all supporting
evidence attached and Sign-off Templates on a memory stick to:
Specialist Audit Advisor – IPIF
System Integration Group
Sector Capability and Implementation
No 1 The Terrace
Ministry of Health
Level 2, Reception
Wellington 6011
Checklist
Have all the Self-Assessment Templates been collated in
numerical order into one document?
Has a Self-Assessment Template been completed for each
Minimum Requirement?
Have all the self-assessment narratives been written in a
comprehensive way?
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Have the self-assessment narratives been written to reflect the
role the PHO takes for each activity? (e.g. funder and/or
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stewardship and/or service provider)
Have the self-assessment responses been written to differentiate
between activities involving the formal Alliance in your area, as
opposed to working in alliance type arrangements with other
partners?
2
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Pre-submission Checklist (optional)
For the Minimum Requirements which are interrelated or
repeated in parts, have separate responses been included or
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cross-referenced clearly to the appropriate sections?
Are the supporting evidence files relevant, reliable, current,
precise, and protecting of patient privacy?
Have supporting evidence files (as appropriate) been attached
and described in the Self-Assessment Template?
Has PHO CEO sign-off been obtained and included on the
memory stick?
Has PHO Board Chair sign-off been obtained and included on the
memory stick?
Has DHB endorsement sign-off been obtained and included on
the memory stick?
Has Alliance agency endorsement sign-off been obtained and
included on the memory stick? (Where applicable)
3
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