The following templates and forms are available for download.
Governance Self-Evaluation Questionnaire
This questionnaire provides an overview of a broad range of governance issues relating to a proposed service and provides the organisation with a tool to assess the adequacy of it's governance structures and processes. (This template has been updated for 2023)
Employment Monitoring Template suggested for Schedule 9
This template is for use in Disability Arrangements in completing Schedule 9. It is suggested best practice for other Care Groups.
Supplementary Information Staffing Template
This is an Excel template used to capture detailed staffing information relevant to a proposed service.
Schedule 9 Template Senior Staff Remuneration Details
This template is a national standard template for collation of senior staff remuneration details as required in Schedule 9 (For use in Non-Disability Arrangements). For Disability Arrangements the senior staff remuneration template is incorporated into a composite Disability template suite (see below). (This template has been updated for 2023)
Schedules 3 9 and KPIs Disability Composite Template (Section 38 and 39)
This is a national standard template for use within the Disability sector. It is used to capture a data for service specification in all voluntary agencies funded by the Health Service Executive. (This template has been updated for 2023)
Schedule 3 Template Basic Input Sheet for Service Specification Quantum (Non Disability Section 38 and Section 39)
This template is for use in all other Care Groups (Excl. Disabilities) where the activity information required for Schedule 3 would benefit from an excel format.
Schedules 3, 9 and KPIs Disability Composite Template (For Profit Agencies)
This is a national standard template for use within the Disability sector. It is used to capture data for service specification in For-Profit/Commercial agencies funded by the Health Service Executive. (This template has been updated for 2023)
Schedule 3 Template - Basic Input Sheet for Service Specification Quantum (Non Disability For-Profit Agencies)
This is a national standard template for use with agencies providing non-Disability services. It is used to capture data for service specification in For-Profit/Commercial agencies funded by the Health Service Executive.
Additional CDNT Schedule 3 Staffing Template
This is a national standard template for use within the Disability sector where there are staff involved in Children Disability Network Teams.
Guide to Schedule 3 Disability Composite Template
This Guide has been updated for 2023.
Chairpersons Statement (sample)
Under the Grant Aid Agreement organisations are required to return a Chairperson's Statement to the HSE. Where organisations to not have an internal format for this they should use this standard proforma document. Organisations should ensure the elements covered in this proforma are covered in any internal reports submitted.
