CSW Employment Package

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Package Nov 2012.docx

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Created on 25-Feb-13

KIRINARI
COMMUNITY
SERVICES LTD

Application Pack
Community Support Worker

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Position Title: Community Support Worker

Location: Group home within any one of the Blue Mountains, Hume-Riverina,
Northern NSW branches

Manager: Supervisor

Thank you for your interest in applying for a position with Kirinari Community Services Ltd. This
information package regarding the position of Community Support Worker contains the following:

A position description which includes the selection criteria
An application form
A physical demands form
The Kirinari Way

Any additional information about our organisation, including services and objectives can be found on
our website www.kirinari.com.au.

Please do not hesitate to contact us should you have any further queries regarding your application

Hume Riverina 02 6056 2111
Northern NSW 02 6721 5011
Blue Mountains 02 4782 9371

The Application

Your application must address the mandatory and any desirable criteria indicated in the Position
Description to be considered for an interview. If you do not meet all of the mandatory requirements
specified in the position description, or cannot clearly demonstrate that you meet the mandatory
requirements, it is unlikely that you will be considered for the position.

It is your responsibility to convince the selection committee that you are the best candidate for the
position. As the selection of candidates for interview is based solely on the information provided in
the application, you must ensure that the information you provide is sufficient for the selection
committee to assess the strength of your application.

Selection on Merit

All appointments to Kirinari are based on merit. This means that each applicant is assessed on merit
against the knowledge, skills, abilities, experience and qualifications identified in the position
description.

The applicant, who demonstrates the most merit against these criteria in their application and at
interview, is recommended for the position.

The Selection Panel

The selection panel is responsible for selecting the best suited candidate for the position. The
selection is based on merit and the selected candidate will best satisfy the selection criteria. The
selection committee must base its decision on material presented by the applicants in writing, at
interview, national police check and from referees.

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Kirinari Community Services Ltd Client Protection

Kirinari is committed to providing quality services to vulnerable clients in a safe environment.
Accordingly it is mandatory that all persons considered for employment at Kirinari include pre-
employment/pre-placement police record checks in their recruitment processes, to minimise the risk
of employing unsuitable people. Similarly Kirinari will review Police Checks for its staff on a regular
basis as required under its various funding agreements. As part of our policy regarding this,
prospective applicants will need to give permission for the organisation to conduct a Criminal History
Check.

Code of Conduct

When you sign your Contract of Employment with Kirinari you commit to working within the
principles and values of our Code of Conduct. It is important for all employees of Kirinari to
maintain the highest standards of service, conduct and behaviour at all times. Maintenance of and
adherence to these standards are essential in Kirinaris relationships with clients, the community, and
in dealing with funding bodies. Our Code of Conduct has been established to ensure that employees
are familiar with and adhere to its core staff values at all times:

Respect;
Integrity;
Accountability;
Impartiality;
Responsiveness; and
Leadership.

Remember, the Kirinari Code of Conduct requires that you commit to professional standards of
behaviour in relation to clients of Kirinari, staff and management of Kirinari, as well as to the general
public.

Image

You should be aware that you will be representing Kirinari. Your conduct and appearance should
present an image that will promote the organisation and reflect a positive and professional approach.
Clothing should be neat and clean and suitable for the job you are doing. Factors to consider are:

The lifestyle of your client or clients
The tasks you will be undertaking eg showering, escorting on an outing etc
Comfort and safety eg closed non-slip footwear, loose fitting clothing
Modesty
Appropriate make-up and jewellery

Smoke-Free Workplace

Kirinari is a smoke-free workplace. Smoking is not permitted in any indoor areas, external areas near
windows, doors and intake vents, or in vehicles used for work purposes.

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Equal Employment Opportunity

Kirinari is committed to providing a safe, flexible and respectful environment for workers and clients
free from all forms of discrimination, bullying and harassment, sexual harassment, and racial and
religious vilification.

All Kirinari employees are required to treat others with dignity, courtesy and respect.

Work Health, Safety, Welfare and Environment (WHS)

Kirinari recognises its responsibilities for providing a safe and healthy workplace. Kirinari is
committed to ensuring that the health and safety of all workers, clients, clients families and the
general public are not put at risk from any undertaking of Kirinari workers or members.
The primary focus of all undertakings within Kirinari will be the safe care and support of our clients
and workers in accordance with the work health and safety laws.
The goal for Kirinari in work health and safety is the pro-active prevention of work related injuries
and illnesses, and the development and promotion of safe systems of work.
Kirinari acknowledges that active co-operation of all workers is required for ensuring a safe and
healthy working environment. Consequently, Kirinari is committed to a consultative approach to work
health and safety.

Kirinari Community Services

Welcome to Kirinari Community Services Ltd.

If you are interested in working in the field of Community Services, you will share meaningfully in
the lives of people with disabilities and older citizen by being involved in their support and
development according to their individual needs and potential. You need to have a genuine interest in
people and a keen desire to help them through understanding, kindness, tolerance and determination.

There is a growing public awareness that people with disabilities are fellow citizens, capable of
learning and development and worthy of the dignity and respect afforded to other members of society.

It is important to realise that your own attitudes towards people with disabilities will influence the role
you play in assisting them through positive ideals. Living and working with people with disabilities
can be challenging and rewarding.

Impairments associated with disability may include intellectual disability, acquired brain injury,
mental health issues, physical conditions, sensory impairments, and/or a lack of basic self-care and
social skills. People who received support through our home care/community care services may also
have a variety of impairments or support needs, which you will need to be mindful of. Sometimes
problems include community resistance and nonacceptance of the integration of older citizens and
people with disabilities into a community. However the stigma is lessening and the worth of every
person, with a disability or not, is becoming accepted.

What are the rewards of working in the Human Services?

In all human services careers, staff will share in the successes and frustrations of the people with
whom they are working. A human service career is especially rewarding when, a person achieves
acceptance and, thus a more normal life. To know that a persons growth and development in ability
and self respect is, in part, the direct result of your own skill and efforts is a reward beyond material
expression.

Where you may work?

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Kirinari is a diverse and large organisation, supporting people throughout the Hume and Riverina
Murray regions of Victoria and NSW. Whether you are supporting people with disabilities or older
citizens, you may be required to work in any location, within your local area.

The Kirinari Story

Kirinari Community Services Limited is a multidimensional provider of support services to people
that are disadvantaged across North Eastern Victoria and throughout NSW. Kirinari has two broad
support programs, our disability division supports people who have disabilities, through our various
accommodation and outreach programs. These are provided through our Branch structure, which
includes branches in the Hume Riverina, the Blue Mountain, and Northern New South Wales.

Our other division is home/community care where we support people that are elderly, people that are
recovering from injury or illness and respite services for people with support needs.

In the early 1980s a supported employment service for people with disabilities called Aware
Industries was set up in Albury-Wodonga. A large number of the people who worked for Aware
required accommodation services and this need let to the creation of Kirinari Residential Services in
1988. In those early years, Kirinari managed 4 residences for people with disabilities.

In 1994, Kirinari management identified that in the future, they would need to get bigger in order to
survive. Kirinari began an on-going process of development and review of its policies, processes and
structures, of assessment of its operations, all with the view of expanding its services and
continuously improving its outcomes.

Along with its corporate office in Wodonga, Kirinari now includes three branch offices. They are
located in Wodonga (Hume Riverina Branch0, in Katoomba (Blue Mountains Branch) and Inverell
(Northern NSW Branch). In total Kirinari manages 21 group homes across the three regions of Hume
Riverina (Albury, Wangaratta, Wodonga and Griffith), Northern New South Wales (Inverell) and the
Blue Mountains (Katoomba, Blackheath and Sydney). Each residence provides support of adults with
a disability. Each residence has up to 24 hour staff support, seven days a week, and accommodates up
to five people.

Kirinari has also expanded into outreach services for people living independently. Outreach services
help people develop their living skills and integration into the community. Kirinari provides aged
care and post-acute care services through its Home/Community Care divisions.

Kirinari is a Not-for-Profit company, governed by a Board of Directors, who employs a Chief
Executive Officer to manage the services provided.

Kirinari receives the large part of its revenue from government funding. Kirinaris supported
accommodation services to people with disabilities are funded in Victoria and NSW by the
Department of Human Services. The services provided by Kirinari are funder under the terms and
conditions in Victoria by the Disability Act (VIC) (2006) and in New South Wales by the NSW
Disability Act (1993). In order to continue receiving government funds, Kirinari has to meet high
standards of service provision at all times. Kirinari also receives some funding from individual
service users and other government departments.

From its small beginnings in 1998, Kirinari now employs over 270 staff and provides services to
around 600 people. But certain things remain the same.

When those first group houses were established in Albury-Wodonga, Kirinari was among the first
service providers working within the spirit of the new laws set up in Australia to promote the rights
and dignity of people with disabilities. The values and principles underpinning Kirinari services are
the same today as they were back at its start: Kirinari is committed to assisting people to live
independently in the community, to make their own decisions and choices, to achieve full and active
participation in the society around them, and to develop the skills they need to go on and achieve
more.

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Over the years, Kirinari has assisted people to make the transition from institutional life into
independent life in the community. It has helped people move from being cared for, to caring for
themselves;. It has encouraged people to learn.

The work Kirinari is Aboriginal for learning. The basic aim of the organisation is to enable
people to maximise their potential for independence which requires learning. You will find that this
aim is reflected in all of the programs that Kirinari offers, and is at the core of the mission of Kirinari.

Kirinari is built on solid values and its future will continue to be supported by those values regardless
of the overall size of the organisation.

Kirinaris Our Mission Our Values

Our Mission is

The deliver quality support services to individuals and families to enable them to lead the lives they
choose.

Our Values

Wherever possible, individuals will be given access to, and have the opportunity to participate
in, general community life;

Services and assistance will always be provided in the least restrictive environment. In all
situations persons will be treated in ways that respect privacy, promote dignity and enhance
self respect;

People will be encouraged and assisted to lead a life that is productive, creative, interesting
and satisfying;

All people shall be respected and treated with dignity;

All people share the same rights, responsibilities and risks associated with community living
as other people;

All people share an entitlement to live in the community with appropriate support under the
same conditions as their fellow citizens and to use the same community services as provided
for their non-disabled peers;

All people shall be actively involved (or when this is not possible represented by their
guardian or advocate) in decisions concerning their health, shelter, education, vocation,
general well-being and other life choices;

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POSITION TITLE:

Community Support Worker (CSW) (casual hours / EFT as negotiated)

LOCATION:

Group home within any one of the Blue Mountains, Hume-Riverina, Northern NSW branches

REPORTS TO:

Supervisor

DIRECT
SUPPORTS:

Supervisor
CSWs within a group home

PRIMARY
FUNCTIONS:
1. Provide support and care appropriate to the individual needs and circumstances of each client;

2. Create a support environment for each individual client that enhances their life, promotes their
independence and maximises their choices about their life;

3. Work flexibly and collaboratively with Supervisors and other staff, to as far as possible meet the individual
needs and preferences of clients.

4. Participate in relevant Work Health & Safety, Welfare & Environment (WHS) processes, including Hazard
ID & Risk Assessment, and on-the-job induction and training;

5. Participate in internal and external training as requested and negotiated;

6. Participate in quality improvement activities

7. Provide individualised, private and confidential support to fellow staff.

KIRINARI STAFF
PHILOSOPHY:
Kirinaris Vision is: to be known for excellence in providing flexible individualised services and support and

Kirinaris Mission is to enable the individuals and families we support to live the lives they choose.

Kirinaris Values are:

Whenever possible, individuals will be given access to, and have the opportunity to participate in, general
community life;
Services and assistance will always be provided in the least restrictive environment;
People will be encouraged and assisted to lead a life that is productive, creative, interesting and satisfying;
All people shall be respected and treated with dignity;
All people share the same rights, responsibilities and risks associated with community living as other people;
All people share an entitlement to live in the community with appropriate support under the same conditions as
their fellow citizens and to use the same community services provided for their non-disabled peers.
All people shall be actively involved (or when this is not possible, represented by their guardian, person
responsible or advocate) in decisions concerning their health, shelter, education, vocation, general well-being
and other life choices.

Kirinari employees warrant that their performance and behaviour will be in accordance with:

Kirinaris Vision, Mission and Values;
the Kirinari Staff Code of Conduct;
all other Kirinari policies, procedures and instructions;
applicable Federal and State legislation, including all applicable service standards;
The contracted terms and conditions of their employment, including any relevant industrial instrument.

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STRATEGIC GOALS:

The 2011-2014 Strategic Plan comprises seven Key Result Areas: Client Service Delivery, Workforce, Governance & Leadership,
Service Development & Sustainability, Infrastructure & Technology, and Quality & Compliance.

Strategic Key
Result Area
1

Client Service
Delivery

Strategic Key
Result Area
2

Workforce
Strategic Key
Result Area
3

Governance
and
Leadership
Strategic Key
Result Area
4

Relationships
and Partnerships

Strategic Key
Result Area
5

Service
Development
and
Sustainability

Strategic Key
Result Area
6

Infrastructure
and
Technology
Strategic Key
Result Area
7

Quality and
Compliance
Goal:
To deliver
services that offer
greater choice
and access and
empowers an
individual to live
the life they
choose

Goal:
To attract and
retain quality staff to
effectively deliver
services

Goal:
To continue
to govern and
lead service in a
viable and
sustainable
manner

Goal:
To build
linkages and
partnerships to
provide greater
choice and delivery
of a client centred
approach

Goal:
To further develop
the service to
meet needs and
take advantage of
opportunities to
expand/
specialise

Goal:
To
guarantee
business
continuity through
provision of
reliable,
appropriate and
current
technology and
infrastructure

Goal:
To
effectively
manage
compliance,
legislative
requirements and
standards of
service at a
Federal and State
level
Objectives:

Review
current
service
delivery
Examine
options to
increase
accessibi-
lity to
services
Continue to
focus on
supporting
our clients
Objectives:

Attract and
retain quality
staff
Enhance
workforce
capacity
Continue to up
skill existing
workforce
Build a future
workforce

Objectives:

Strengthen
governance
support
Ongoing
develop-
ment of
leadership
capacity and
capabilities

Objectives:
Form strategic
alliances
Explore
partnership
opportunities
Strengthen
community
connections
Objectives:
Examine
future
service
options
Increase
capacity to
coordinate
over large
geographic
area
Continue to
build
reputation
Focus on
modernis-
ing image
Continue to
undertake
responsible
Financial
Manage-
ment

Objectives:

Address
technology
capacity
across all
sites
Upgrade IT
systems
Review
housing
infrastruc-
ture
Objectives:

Continue to
implement
Quality
Framework
Further
expand
monitoring
review and
evaluation
processes

The position of Community Support Worker works mainly in the Key Result Areas 1, 2, 4, 5 and 7 as part of the team within
their group homes, however they also work within their Branch, and together with all other staff at Kirinari, to achieve strategic goals
and outcomes across the other Key Result Areas.

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SPECIFIC RESPONSIBILITIES:

1. Person-centred
services
Implement procedures and practices that support the delivery of individualised, sensitive and
effective services for clients, including:
Supports required to assist clients achieve their preferred outcomes are identified by talking
with the client, their significant others and other service providers as required;
Collecting resident feedback and preferences from clients meetings;
Client preferences and choices are documented within their About Me Plan;
About Me My Choices and Support Plan are developed for each client on a timely basis to
record choices and support and reviewed annually;
Consistent supports are provided to each client in line with all of their My Choices and Support
Plan;
Implementation of support is monitored daily via review of documentation, including Progress
Notes, Incident Reports, Personal Cash Book, file notes, communication book, diaries etc
Report to and liaison with the Supervisor to obtain assistance and direction;
Recognition of the diversity of individuals;
Development of appropriate communication systems and methods for each individual;
Effective communication with clients, their families and significant others as appropriate;
Facilitating community access & linking clients to relevant services; and
Completing hands-on support as necessary when clients are at home;

2. Administration &
Compliance

Review of Kirinari database documentation for each client daily, including Progress Notes,
Incident Reports, Cash Book, Housekeeping and other systems as required;.
Individual clients applicable behavioural support reporting requirements, including restrictive
practice authorisations (RPA) and restrictive intervention data system (RIDS)
Implement WHS including hazard ID, risk assessment and risk control measures in the group
home;
Monitor and comply with house budgets;
Notify Supervisor on a timely basis of any maintenance requests for the group home;
Communicate on a timely and as-needed basis with clients families, guardians, medical
professionals and significant others;
Participate in and contribute to quality assurance audits to disability standards.

3. Policy, procedure,
protocols &
practice
Documentation of policies, procedures, protocols and practice instructions including:
Routines, practices and protocols for individual clients in the group home;
Group home procedures and work instructions for consistent and smooth team operation;
Individual file notes for individual clients as appropriate;
Incident and investigation reports as required and requested;
Upholding Kirinari policies, procedures and protocols in relation to service delivery;
Ensuring policies and procedures are implemented and complied with, in the group home.

4. Service Planning
& Development
Assist Supervisor to
identify opportunities for improvement to existing services and systems;
increase opportunities for residents to participate in their communities through developing
and reviewing in-house quality plans;
promote Kirinari services and advocate for its clients in the community;
promote Kirinari workplaces and encourage new staff to join us eg information sessions

MEETINGS

Attend staff meetings as rostered;
Attend client planning meetings as requested by clients or Client Services Coordinator / Service
Planning Coordinator;
Attend other meetings as required and/or approved by the Branch Manager.

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INFORMATION AND
COMMUNICATION
TECHNOLOGY

Utilise Kirinari custom databases to maintain records;
Utilise Microsoft Office suite to generate documentation;
Utilise internet browsing and research skills;
Use online reporting & notification systems as required for funding providers;
Maintain knowledge of privacy and confidentiality legislation with regard to all records,
documentation and information and their application to clients and staff.
Utilise and problem solve with technology as required eg assistive technology, lifting devices,
office machinery, household appliances.

QUALITY
ASSURANCE

Contribute to all Branch audits for compliance with service quality assurance systems, such as:
Integrated Monitoring Framework (IMF) (NSW)
Victorian Quality Framework (VQF) (Vic)
National Quality Standards (NQF) (Fed)

QUALIFICATIONS Mandatory: Community Services or Human Services qualifications - Certificate III or higher
Mandatory: Current Australian Drivers Licence
Mandatory: First Aid Certificate (Level 2) or to obtain within 4 weeks of employment

Highly Desirable: Proficiency in Microsoft Office 2007 suite
Highly Desirable: Experience with databases and Internet Explorer

Desirable: Knowledge of / experience working with Behaviors of Concern / Challenging
Behaviours
Desirable: Report / Recording skills
Desirable: Heightened Non Verbal / Verbal skills
Desirable: Flexibility
Desirable: Ability to work within budgets
Desirable: Knowledge / experience working within Personal centered planning

EMPLOYMENT
CONDITIONS
As detailed in an individual Employment Contract, described by the Letter of Offer, Terms and
Conditions, Staff Code of Conduct, and relevant industrial instrument

SELECTION
CRITERIA
Appropriate and current tertiary qualifications, or partial completion thereof with a willingness to
achieve completion;
Demonstrated skills and experience in the identification of individual needs and choices, and in
the development and implementation of individual plans to meet those needs and choices;
Working knowledge of the theory and experience of person-centred thinking in disability
services, and current legislation around human services;
Working knowledge of current and applicable quality standards in disability service provision;
Ability to communicate effectively with people;
Demonstrate a holistic and flexible approach to individualised support;
Commitment to own professional development and ability to facilitate learning;
Excellent computer and data management skills;
Excellent time management and prioritising skills;
Work or life experience (2+ years) in delivering services to people with a disability;
Demonstrated ability to contribute to and support a team effort;
Ability to communicate with a diverse range of people;
Negotiation skills in a wide range of situations;
Ability to recognise and resolve conflict and demonstrate resilience.
First Aid Certificate
Drivers Licence

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1A Footmark Court
(P O Box 981)
Wodonga Vic 3690
Ph: 02 6056 2111
Fax: 02 6056 3349
Email: careers@kirinari.com.au
APPLICATION FOR EMPLOYMENT

Thank you for your interest in working with Kirinari Community Services Ltd. All applications are treated
confidentially.
Please complete all sections of this form in your own handwriting.

Details of Vacancy
Position applied for:

Branch/Region/Location:

What is your availability for work?
(please tick)
Full time Part time Casual
Are you currently, or have you previously been, employed by Kirinari?
(please tick)
Yes No

Applicant Details
Title (please tick): Ms

Mrs

Miss

Mr

Other

Surname

Given Name(s):

Preferred Name(s):

Address:

Suburb / City State Postcode

Contact Details
Phone No: Mobile No:
Email:
Preferred Contact Method? (tick) Phone: Mobile: Emaill

Current Licences
Do you hold a current Drivers Licence?
(please tick)
Yes No Licence No:
Do you hold a current First Aid certificate?
(please tick)
Yes No If Yes,
Expiry Date:

Verification of Work Status
Are you an Australian Citizen or Permanent Resident?
(please tick)
Yes No
If not, do you hold a valid working visa
(please tick)
Yes No
(If you hold a valid working visa, please provide a copy of passport and applicable visa)

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Medical Information
Do you have any health problems or a medical condition which may affect your ability to
perform the inherent requirements of the position applied for as specified in the position
description attached to this application?

Yes

No

If yes, please give details

Would you agree to undergo a medical examination to assess your suitability to be able to
carry out the inherent requirements of the position applied for?

Yes

No

Employment History
Please give details of your current or most recent employer

Employers Name:

Address:

Position Held:

From

to

Supervisors Name:

Telephone No.:

Reason for Leaving:

Do we have your permission to contact your current employer? (please tick) Yes No

Enter the details of the last four positions you have held, not including the one you have listed above:
Employer Name: Location: Positon Held Start Date End Date Reason for Leaving

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Qualifications/Education
Secondary Education:
HSC/VCE School Certificate Other

Tertiary Education:
Date Qualified Qualification Name Institution Name Duration (Mths)

Training: (please list)
Date Qualified Course Name Institution Name Duration (Mths)

Membership of relevant professional bodies, associations: (please list)

Verification of identity and entitlement to work in Australia
Please provide a certified copy of one (1) of the following four documents. The original document will need to be sighted when
accepting your documents. If you are the holder of a VISA then your right to work and any restrictions will be verified with the
Department of Immigration and Citizenship through VEVO or the Visa Entitlement Verification Faxback service.

Australian or New Zealand
Passport
Full Australian Birth Certificate
Australian or New Zealand
Citizenship Certificate

Overseas passport with confirmation of a current temporary work VISA and its expiry date

Overseas passport with VISA details Holder(s) permitted to remain in Australia indefinitely

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Criminal History Check
All successful applicants are required to consent to undergo a National criminal records check as a condition of employment. By
completing the following question you are consenting to undergo a National criminal records check.

Have you ever been convicted* of a criminal offence? Yes No
*To be convicted a court would have made a finding that you were either:
Convicted by a single judge or jury of the offence
Guilty of the offence(s) charged but dismissed without conviction

Referee List
Please list below three referees whom you give your consent to us contacting, regarding your suitability for the position:
Name Telephone/Mobile Company Name & Position Held Relationship to you & your role

Are there any other details relevant to the position you are applying for which you would like us to consider?

DECLARATION BY ALL APPLICANTS:
I understand that all offers of employment are conditional upon satisfactory reference and background checks being obtained, (including
National criminal record and pre-employment medical checks, as relevant and required for the position) and the production of all
documents necessary for Kirinari to verify my identity, qualifications and ability to work in Australia. I consent to the authorised
representatives of Kirinari contacting any person(s) or institutions relevant to this application to undertake these verifications and checks.

I certify that the information provided in this application is true and complete to the best of my knowledge, information and belief. I
understand withholding pertinent information or submitting false or misleading information on this application, my resume, during
interviews or at any other time during the hiring process, may result in my disqualification from further consideration for employment or if I
am employed, the termination of my employment. I confirm that I have completed this application in my own handwriting.

I acknowledge that all Kirinari workplaces and vehicles are smoke free as part of our non smoking policy.

Applicants Signature: ______________________________________________ Date: / /

Any supporting documentation should be attached to this application form. Any application not fully completed may be deemed not
acceptable and eliminated from consideration.

NOTE: Kirinari is an Equal Opportunity Employer. Kirinaris Employment Policy is that the best person for the position will be
appointed, but reserves the right to make no appointment if no applicant is deemed to satisfactorily meet the selection criteria.

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PERSONAL DECLARATION IN RELATION TO CRITICAL
PHYSICAL JOB DEMANDS

Name: _______________________________________________________

Position: ____________________________________________________

You have applied for a position with Kirinari Community Services Ltd.

This position may involve critical physical job demands summarised as follows.
Please tick the boxes to indicate that you have read and are able to undertake the following:

Capacity to sit frequently
Capacity to stand frequently
Capacity to walk over uneven and even ground frequently
Capacity to climb steps and stairs frequently
Capacity to perform repetitive forward reach with both upper limbs
Capacity to perform repetitive neck rotation
Capacity to perform repetitive neck extension
Capacity to perform repetitive neck flexion
Capacity to perform lower back rotation frequently
Capacity to perform repetitive elbow flexion
Capacity to perform repetitive gripping
Capacity to carry up to 10kgs frequently
Capacity to kneel, crouch or squat frequently
Capacity to perform frequent fine hand manipulation of both right and left hands
Capacity to perform frequent side reaching
Capacity to perform frequent tripod grip (eg. To hold a pen)
Capacity to perform frequent low back rotation
Capacity to perform frequent wrist flexion, ulna and radial deviation

Environmental Issues

Working inside and outside
Working in hot and cold weather
Working in wet and dry conditions

(Please note that these descriptions have been written to describe the critical physical
demands for an able bodied person performing the tasks associated with this Job. Any
person with a disability should not view these descriptions as a barrier to their employment.
Kirinari Community Services Ltd is aware of its responsibilities under the Disability
Discrimination Legislation and would appreciate disclosure of any Information that may be
required to allow us to assess modifications to the workplace in terms of the Disability
Discrimination legislation and enable to enable us to provide a safe system of work for all our
employees in compliance with our occupational health and safety obligations.)

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1. Have you suffered an injury or disease that could be affected by performing the
physical duties of this position, as outlined above. This includes any condition that
you are already aware of could reasonably be expected to foresee. If the answer is
yes, please provide details of those injuries and/or diseases:

_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________

2. (a) Please identify which specific tasks, duties and/or responsibilities (as outlined
above) you know or which you could reasonably be expected to have foreseen may
affect the injuries and/or diseases you have disclosed:

_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________

(b) Please identify aids or workplace modifications that would allow you to perform
the tasks and responsibilities as outlined above:

_________________________________________________________________________
_________________________________________________________________________
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For occupational health and safety and workers compensation insurance purposes (in
Victoria, pursuant to Section 82(7) of the Accident Compensation Act 1985), Kirinari
Community Services Ltd requires you to provide information regarding any injuries or
diseases you may have or have had which could be affected by performing the duties of this
position.

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(IMPORTANT: If you do not disclose an injury or disease of which you are aware or could
reasonably be expected to have foreseen could be affected by the nature of your
employment, or make false or misleading disclosures, you will not be entitled to claim
workers compensation in the event you suffer a recurrence, aggravation, acceleration,
exacerbation or deterioration of that injury or disease arising out of or due to the nature of
employment with the Kirinari Community Services Ltd).

Do you understand your responsibilities to disclose any previous injuries or
diseases?

Yes No

Name: _____________________ Signature:_____________________ Date: / /

Note:
This form is required to be completed and along with the relevant National Police Check
Form and returned to Human Resources. Kirinari will not offer employment to any person
who has failed to return this form as requested due to our occupational health and safety
obligations.

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CSW Employment Package

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