Implementation Guide for the CANDOR Process: Appendix C

Organization Team Roster

Purpose: To confirm understanding of expectations by team members.

Who should use this tool? CANDOR Implementation Team Leader and other Team Leads.

How should you use this worksheet? Each member of the CANDOR Implementation Team should sign this form.

Team Role Name Credentials Title Signature Date
CANDOR Implementation Team Lead          
Disclosure Team Lead          
Care for the Caregiver Team Lead          
Event Reporting, Investigation, and Analysis Team Lead          
Resolution Team Lead          
Physician Champion          
Nurse Champion          
Patient and Family Advisors          
Risk Management Champion          
Direct Patient Care Team          
Indirect Patient Care Team          

Return to Contents
Proceed to Appendix D

Return to CANDOR Contents

Page last reviewed February 2017
Page originally created April 2016
Internet Citation: Implementation Guide for the CANDOR Process: Appendix C. Content last reviewed February 2017. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/professionals/quality-patient-safety/patient-safety-resources/resources/candor/impguide-apc.html