Clinical Care Capacity Sheets – Reporting Concerns in your Workplace

Following a Zone Level Management Committee meeting this week it was brought to the NSGEU’s attention that a reminder re Clinical Care Capacity Sheets would be beneficial. These sheets are integral in documenting health and safety concerns occurring in your workplace.

A nurse who believes that adequate and safe care of patients cannot be provided because of workload should bring the matter to the attention of the immediate supervisor or designate, if possible on the shift, this could include the bed manager. In addition, nurses should complete this form and submit the original to the employer, fax a copy to their union and retain a copy for themselves. Only one form per shift is needed and if possible all staff working the shift should sign the form.

The process is straightforward:

  • You can find a copy of the Clinical Care Capacity Sheets here: (
  • These forms are important to use in the events of workload, staffing and safety issues.
  • You have 72 hours from the incident to fill out the form, and only one form per shift is necessary, but all nurses on the shift should sign it.
  • Fill out the form, fax it to the union and leave the original with your manager. The fax number and guidelines can be found at the bottom of the form.
  • These Clinical Care Capacity Sheets do not replace SIMM or SAFE Reporting. They should be used in conjunction with these two other protocols.

If you have further questions or concerns about this matter, please contact us. Keep an eye on your email for further updates from us on this important issue

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