APPLICATION FOR ACCREDITATION OF LABORATORY FOR TRAINING CANDIDATES IN FORENSIC PATHOLOGY Please refer to policies when preparing your application. All information will be treated with strictest confidence by the Board of Education and Assessment (BEA) Note: No application will be considered without the following: (1) Attachment of a Training Program with detail of progression through the 5 years of training. (2) Detail of how competency will be maintained in areas not adequately covered in the training lab. Please complete all sections of this form, sign and return to College. Lab Name: Address: Area Health Service / District Health Board (if applicable): Telephone (switch): Fax: Contact person for application? Date: Telephone (direct): Email: RCPA ID No (if applicable – refer to RCPA lab accreditation letter): Director / Departmental Head of Laboratory Service: If applicable, Director / Departmental Head of Forensic Laboratory Service Accreditation (NATA, IANZ, IS015189) Is the Forensic Diagnostic Laboratory accredited? Discipline category (if relevant) Accreditation agency? Current accreditation From: period External proficiency program(s) List program(s) that the laboratory currently participates in (RCPA/ QAP; EMQN; CAP; etc) Document Number: D126783 1 Document Name: Forensic Lab Accreditation Application form Sept 2011 Document Path: BOC - Lab accreditation - Forms - Current Accreditation application forms To: Supervision Supervisor(s) of Trainees (if shared supervision, please indicate primary supervisor) Number of funded EFT Pathologist positions with the Forensic Laboratory Service Pathologists, with their qualifications, contributing to the training program (add extra lines if required) Name Qualifications Scope(s) of practice Date of appointment % of week in laboratory Other medically qualified staff providing essential training (add extra lines if required) Name Qualifications Date of appointment % of week in laboratory Senior Scientific and Tech staff contributing to Trainee supervision (add extra lines if required) Name Qualifications Area of technical expertise NOTE: The RCPA should be informed of any periods of extended absence, long service leave or sick leave of the supervisor/s. To ensure ongoing continuity of training the RCPA must be informed of the relief arrangement. Document Number: D126783 2 Document Name: Forensic Lab Accreditation Application form Sept 2011 Document Path: BOC - Lab accreditation - Forms - Current Accreditation application forms Forensic Trainees Please indicate the number of trainees you wish to accommodate at any one time Duration of Training considered appropriate (in years)? Please note It is College policy to limit training in one institution* to a maximum of four years. Number of current trainees Total no. trainees over past 5 years Name Discipline Year training started Duration of Forensic training? Exam progress? Training facilities Comments (if applicable) Professional Journals/ Library Computer/ Internet facilities Other (e.g. learning and teaching aids, etc) , Laboratory Workload Please indicate your laboratory workload:(i) Autopsies Population base serviced by Unit per annum Total autopsies by Unit per annum Total Homicides and suspicious deaths per annum Infant autopsies (0 - 3 yrs) per annum Child and youth (4 – 18yrs) per annum Trauma deaths per annum Suicides per annum Adult natural causes per annum Hospital death, coronial referrals per annum External only examinations per annum Document Number: D126783 3 Document Name: Forensic Lab Accreditation Application form Sept 2011 Document Path: BOC - Lab accreditation - Forms - Current Accreditation application forms Skeletal remains examination per annum Non-coronial autopsies by unit per annum Perinatal per annum Adult clinical autopsies per annum Infectious/contagious disease cases per annum (ii) Clinical Forensic medicine a. Does the unit provide this service b. Cases per annum Describe type of service __________________________________________________________________ __________________________________________________________________ (iii) Toxicology a. Does the unit have an in-house toxicology service b. How many cases from autopsies processed per year c. How many non-autopsy cases processed per year (iv) Surgical pathology a. Does the unit provide any non-autopsy based surgical pathology service? Describe. __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ *To ensure that candidates for RCPA qualifications are exposed to more than one style and philosophy of pathology practice, they are ordinarily limited to spending a maximum of 4 years training in one laboratory. Where the same members of a pathology service/practice supervise geographically separate laboratories, this may be viewed as training undertaken in a single laboratory and may not fulfil the College requirements for employment in a different institution unless significant differences in practice and supervision can be demonstrated. To assist the College in monitoring the above policy, please list all regular rotation arrangements below, specifying whether they are internal or external (i.e. to an operationally distinct service or geographically separate site with different management, practice and supervision). Please note that if Trainees participate in an external rotation, that site is required to be separately accredited. Document Number: D126783 4 Document Name: Forensic Lab Accreditation Application form Sept 2011 Document Path: BOC - Lab accreditation - Forms - Current Accreditation application forms Discipline Site Type of Rotation Internal External Internal External Internal External Internal External Internal External Internal External Purpose of Rotation Please indicate any additional areas listed under the discipline check lists in the Trainee Handbook for which your laboratory is unable to provide training on site. Please state how these areas are/will be covered. Signature: ________________________________________ Date: _____________________ Completed application forms, together with all relevant training programs and other supporting documentation, should be forwarded to the Registrar at the Royal College of Pathologists of Australasia. You will be advised of your accreditation status following the next meeting of the Board of Education and assessment (BEA)/ and or determination by the Chief Examiner. Email to lab@rcpa.edu.au fax to 0015 61 2 8356 5828 or mail to RCPA, 207 Albion Street, Surry Hills NSW 2010 Australia. Thank you for your support of pathology training. PLEASE NOTE THAT YOUR APPLICATION WILL NOT BE ACCEPTED WITHOUT A TRAINING PROGRAM Document Number: D126783 5 Document Name: Forensic Lab Accreditation Application form Sept 2011 Document Path: BOC - Lab accreditation - Forms - Current Accreditation application forms