Community Engagement Intake Form

Hello and thank you for taking the time to complete this community engagement intake form.

It will take 10-15 minutes to complete. Good community engagement starts with establishing a clear understanding of what you need to know, why you need to know it and who you need to hear from. Once our Community Engagement team receives the completed request, we will review as a team and get back to you within two weeks.

If your project requires engagement and the final findings report within 4 weeks, please be aware that best practice is 8 weeks. We will always do our best to support you with urgent and/or short timelines – we are balancing organizational priorities with the respecting public advisors and community partners request to say yes to requests (i.e. adequate time to prepare and get involved).

*** If you do not know the answer to a question in this form, please answer it to the best of your ability ***

Please email us at ce@vch.ca if you have any questions.

Thank you,

The VCH Community Engagement team

Key contact person (name, role, department)

Maximum 255 characters

0/255

Phone number

Maximum 255 characters

0/255

Community of care

Select option

Project Information

Project or initiative name

Maximum 255 characters

0/255

Background information about the project/initiative:

Maximum 20,000 characters

0/20,000

What is the project trying to achieve and by when?

What stage are you at in your project?

Planning / design in progress

Ready to start (approved and resourced)

In progress / implementation underway

Reporting

Evaluation

Who is included in the governance model for this project/engagement?

VCH-led (VCH is the primary decision-maker)

Partner-led (external partner is the primary decision-maker)

Shared governance (VCH and partners jointly lead)

Other (please specify)

Engagement

Please indicate if an Executive Sponsor (VP level) has approved the engagement. If so, provide their name and role. Please also include any other final decision maker(s) for your project/initiative.

Maximum 20,000 characters

0/20,000

10.

Has a budget been approved for engagement? If yes, what is the approved budget?

Maximum 20,000 characters

0/20,000

11.

Who is the intended audience for the engagement?

Internal

External

Internal and External

12.

Please select who will be most impacted by the decision(s) being made:

Clients/patients/consumers/residents

Family members

Caregivers

Organizations

Groups

Staff and Medical Staff (at VCH)

Other (please specify)

13.

How many people do you expect we should hear from during the engagement?

1-5

6-10

10-20

20+

Other (please share details):

Examples include: mailing list, existing committee, previous engagement(s)

14.

Why are you seeking input from these individuals or groups?

(e.g. feedback on existing document, plan or project (including concerns or validation); contributing ideas on document, plan or project; ongoing feedback and ideas at multiple points of a project or plan)

Maximum 20,000 characters

0/20,000

15.

In your project/initiative, what decisions are not open to feedback from these individuals or groups?

Maximum 255 characters

0/255

Examples include: creating new programs, design guidelines, whether the project/initiative will happen, and more.

16.

Are there any particularly sensitive or controversial aspects to your project/initiative that we should know about?

Maximum 255 characters

0/255

Examples include: controversial topics, previous negative engagement experiences, disagreement between key participants, and more.

17.

Do you plan to report back to participants?

Yes

Not sure/ undecided

Other (please specify)

18.

When do you (ideally) need the engagement to be completed and the findings report delivered to inform your project/initiative?

Our team will work back from this date to determine when we create an engagement plan and implement the plan.

Level of engagement

"Level of engagement" refers to how involved individuals and groups (patients, clients, consumers, residents, families, organizations, public) will be in this process as well as their level of influence. All the levels create a "spectrum of involvement".

This spectrum is adapted from the International Association for Public Participation (IAP2) and is found in the Ministry of Health's Patient, Family, Caregiver and Public Engagement Framework (2018).

19.

Please indicate below which level(s) of engagement you are seeking. You may select different levels depending on who you have in mind to engage.

Inform - “We want to let individuals know about what we are doing and what it means for them.” This is the first part of all engagement processes.

Gather - “We want to let individuals know about what we’re doing and gather their feedback (on a draft), which we’ll then take into consideration in our decision-making.” We are still at a stage where decisions are still being shaped.

Involve - “We want to ensure that we are hearing from individuals before anything is created, so that they are directly reflected in our decision-making throughout the project.” This level of engagement encourages discussion among/with individuals.

Collaborate - “We want to bring individuals in as partners in all aspects of the decision(s) to be made throughout the process of this project.” This level of engagement allows for individuals to shape policy and program decisions that affect them.

Lead - “We want individuals to make this decision(s). We will implement what they decide.” This level of engagement asks the individuals to be the decision makers.

Other (please specify)

Thank you!