grant application guidelines - department of health, victoria · extended care units, residential...

Mental Health and Alcohol and Other Drug Services Capital Grant Program

Facilities Renewal Grant

Mental Health Safety and Privacy Grant

Grant Application Guidelines

Contents

Guidelines .................................................................................................................................................................... 2

1 About the Grants .............................................................................................................................................. 2

2 Who can apply? ................................................................................................................................................ 2

3 What Types of Activity might be funded? ...................................................................................................... 2

Mental Health Facilities Renewal Grants ........................................................................................................... 2 3.1

Alcohol and Other Drugs Facilities Renewal Grants .......................................................................................... 2 3.2

Mental Health Safety and Privacy Grants .......................................................................................................... 2 3.3

What will not be funded? .................................................................................................................................... 2 3.4

4 What level of funding can you apply for? ...................................................................................................... 3

5 What are the Funding Timelines? ................................................................................................................... 3

6 Proposal requirements .................................................................................................................................... 4

7 Grant Process ................................................................................................................................................... 5

7.1 Submission of proposal ...................................................................................................................................... 5

Assessment of Proposals ................................................................................................................................... 6 7.2

Notification of successful / unsuccessful Proposals ........................................................................................... 6 7.3

Reporting Requirements ..................................................................................................................................... 7 7.4

8 Appendix 1: Eligible services .......................................................................................................................... 8

9 Appendix 2: Application form ....................................................................................................................... 1

CEO’s declaration ............................................................................................................................................. 11 9.1

10 Appendix 3 – Reporting - Interim Report Template .................................................................................... 12

11 Appendix 4 – Reporting - Final Report ......................................................................................................... 13

2

Guidelines

1 About the Grants

The Victorian Government has committed $5 million in 2015-16 to invest in improving facilities that provide

community Mental Health and Alcohol and Drug Services. A further $500,000 is committed to support safety and

privacy in Clinical Mental Health Community Care Units and Mental Health Community Support Service Residential

Rehabilitation facilities.

1.1. Why is the Victorian Government funding these grants?

The Mental Health and Alcohol and Other Drug Services Capital Grant Program is designed to encourage:

Addressing problems relating to building condition and compliance according to Australian Standards due to aged and poor quality facilities

Improving safety, including for staff, women and vulnerable persons

Making facilities fit for purpose to contemporary standards improving effectiveness and efficiency in service delivery to achieve client and carer outcomes.

2 Who can apply?

Selected Victorian Government funded services that are considered as:

Mental Health Clinical community based services including Community Care and Secure Extended Care Units

and Residential Rehabilitation services

Alcohol and Other Drug service providers including Counselling and Support, Withdrawal, Residential and

Specialist Services.

See Appendix 1 for details.

3 What Types of Activity might be funded?

The Mental Health and Alcohol and Other Drugs Capital Grant Program will support highest priority, highest service

risk minor capital works projects at Mental Health Clinical community based services, Community Care and Secure

Extended Care Units, Residential Rehabilitation Services and Alcohol and Other Drug Services community based

providers.

As this is a capped program not all eligible Proposals will be funded.

Mental Health Facilities Renewal Grants 3.1

The Mental Health Facilities Renewal Grants will support the highest priority, highest service risk minor capital

works projects at community based clinical services, Community Care and Secure Extended Care Units and

Residential Rehabilitation Services.

2

Grants from this minor capital works program can be used for:

Addressing problems relating to building condition and compliance according to Australian Standards due to

aged and poor quality facilities

Improving safety, including for staff, women and vulnerable person

Making facilities fit for purpose to contemporary standards improving effectiveness and efficiency in service

delivery to achieve client and carer outcomes.

In addition, the Victorian Government has a focus on improving facilities that are owned by the Victorian

Government or Service Provider agencies that provide quality treatment and care and are located in the community

they serve. Consideration may also be given to facilities that are owned by private entities.

Alcohol and Other Drugs Facilities Renewal Grants 3.2

The Alcohol and Other Drug Facilities Renewal Grants will support the highest priority, highest service risk, projects

at community based, acute withdrawal and residential services.

Grants from this program can be used to:

Address problems relating to building condition and compliance according to Australian Standards due to aged

and poor quality facilities

Improve safety, including for staff, women and vulnerable persons

Make fit for purpose to contemporary standards improving effectiveness and efficiency in service delivery to

achieve client outcomes and support recovery



they serve. Consideration may also be given to facilities that are owned by private entities.

Mental Health Safety and Privacy Grants 3.3

Grants from this program can be used to:

Improve safety, privacy and access by the installation of electronic swipe system locks on bedroom doors that

provide consumer lockable bedrooms in Clinical Mental Health Community Care Units and Mental Health

Community Support Service Residential Rehabilitation facilities.



they serve.

What will not be funded? 3.4

Routine, ongoing maintenance or recurrent operating costs

Works that do not meet the highest priority need

The purchase of land or assets including buildings or vehicles

Capital works that have already started at the time of application/ notification of grant outcomes

Works that have previously been funded

Projects that do not meet the grant criteria

Works that do not meet relevant Australian Standards

Works that are not in line with relevant guidelines for service provision

Works primarily for information and technology communications

3

4 What level of funding can you apply for?

Category Grant Funding

Available

Funding Use

Mental Health Facilities Renewal

Grant

Minimum

$10,000

Maximum

$500,000

To support the highest priority, highest service

risk, minor capital works projects at community

based clinical services, Community Care and

Secure Extended Care Units and Residential

Rehabilitation Services.

Alcohol and Other Drugs Facilities

Renewal Grant

Minimum

$10,000

Maximum

$500,000

To support the highest priority, highest service

risk, minor capital works projects at community

based alcohol and other drug treatment services,

counselling and residential services.

Mental Health Safety and Privacy

Grant

N/a

$ 50,000

To improve safety, privacy and access by

installation of electronic swipe system locks on

bedroom doors that provide consumer lockable

bedrooms in Clinical Mental Health Community

Care Units and Mental Health Community

Support Service Residential Rehabilitation

facilities.

Minor works refers to:

Small construction and remodelling improvement projects that address areas of highest priority needs of the

physical building (i.e. Water, gas, electricity, structural, disability access)

5 What are the Funding Timelines?

The grant round will follow the following program:

Deadline for submission of proposals Close of business Monday,

30 November 2015

Proposals evaluated February - 2016

Recommendations approved April - 2016

Individual projects commenced June - 2016

Individual projects completed June - 2017

4

6 Proposal requirements

Proposals from eligible Victorian public health and non-government organisations for the Mental Health and Alcohol

and other Drug Facilities Renewal Grant and Mental Health Safety and Privacy Grant program open on 5 October

2015 and close on Monday 30 November 2015. Applicants are encouraged to submit their Proposals by the due

date with all relevant information requested.

The application form is available at Appendix 2.

When developing your proposal you must:

Determine and address problems of highest need relating to building condition and compliance according to

Australian Standards due to aged and poor quality facilities such as:

Ensure compliance with various accreditation and practice requirements (e.g. Australian Standards for

Buildings, Fire Safety, Work Safe and Infection control).

Risk management works, including security that will reduce operational risk.

Projects related to improving Occupational Health and Safety (OH&S), disability access, consumer safety and/or

public safety.

Works that align with the program objectives of enhancing the condition of the facility and maintaining service

delivery and consistent with current service planning expectations.

Discuss your proposals with:

Consumer and carer representatives

The Department of Health & Human Services representatives

The following should be noted when developing your proposal:

(a) The proposal should demonstrate alignment with the longer term strategy of the facility and the agency’s

designated role, Victorian Government policy and the aims of the grant program.

(b) Funding is available for minor capital improvements, additions or refurbishments including buildings, safety

issues and associated furniture fittings and equipment (excluding medical ant IT equipment).

(c) Capital works funded under this program are for property owned or controlled by the Victorian Government or

funded mental health or Alcohol and Other Drugs agencies.

(d) Funding may be considered for property not owned or controlled by the Victorian Government or agencies. It

is preferred that such property should not be mortgaged nor encumbered. However, in such circumstances

the Department of Health & Human Services will require a legally binding agreement with the mortgagee or

charge of the property.

(e) All requests for funding should be shown exclusive of GST.

(f) Major capital works proposals will not be considered and therefore should not be submitted to this program.

Proposals that are eligible to seek funding under other state or federal will not be considered under this

program.

(g) All agencies are required to indemnify the Department of Health & Human Services and have appropriate

insurance cover. Proposals may demonstrate a level of financial and/or in-kind support from sources other

than the Victorian Government, such as agency and community contribution (including both financial and non-

financial contributions).

(h) Funds will be made available as a one-off grant only, thus applicants should demonstrate that project viability

is not dependant on continuing or recurrent Victorian Government funding.

5

(i) The project(s) will be funded through a grant process and will be directly managed by the health or community

service.

(j) Funding will not be granted in retrospect, and project(s) that have already commenced will not be considered.

Detailed costs in relation to proposed minor capital work project(s) must be submitted in conjunction with your

application for consideration by the Department of Health & Humans Services (a cost plan template is included

in the application form).

(k) Documentation including quotes, invoices and photographs should be maintained and submitted as part of the

application process

(l) In relation to furniture, fittings and equipment, quotations with evidence of anticipated cost are required to be

included as part of the submission, in accordance with Victorian Government Procurement Guidelines.

(m) Procurement must be focused on achieving best value for money, consistent with Department of Health &

Human Services and Victorian Government policies and guidelines.

7 Grant Process

7.1 Submission of proposal

Due Date: 30 November 2015 – 4pm

All organisations submitting a proposal/s must complete this application form and include relevant supporting

documentation (for example: cost plans; quotations; other relevant supporting information). Services are required

to denote the priority order of each application. Note: Only one property per application form.

Proposals must be received no later than 30 November 2015 – 4pm to be eligible for consideration by electronic

copy only. Late, incomplete, facsimiled, hand delivered or proposals delivered by mail will not be accepted.

All submissions must be submitted via electronic copy to [email protected]

All proposals will receive a confirmation email upon receipt.

Services that fail to meet the deadline as a result of IT failure will not be subject to any special considerations.

To avoid such issues, services are encouraged to submit proposals prior to the due date.

Please ensure:

The application form is submitted as a word document.

The CEO declaration is completed and submitted as a scanned electronic document in pdf format. Electronic

signatures will not be accepted.

The file attachments have the following naming convention:

Service Name_Project Title_ Application no. 1 or 2.doc

Service Name_Project Title_CEO Declaration.pdf

Service Name_Project Title_Attachment 1.doc/pdf

(repeat as required for multiple attachments).

The Department of Health & Human Services reserves the right to request additional supporting information in

relation to any application submitted to the Mental Health and Alcohol and Other Drug Services Capital Grant

Program.

mailto:[email protected]

6

Assessment of Proposals 7.2

All Proposals will be assessed by a panel comprising of Department of Health & Human Services representatives.

All Proposals will be considered in the context of the Mental Health and Alcohol and other Drug Facilities Renewal

program objectives, a state-wide priority context and the project(s) alignment with Victorian Government objectives.

Proposals for grants will be assessed against the following criteria:

Criterion 1 The application demonstrates alignment with the aims of the grant

program, the organisation's designated role, long-term strategy, and

Victorian Government policy.

Criterion 2 The application includes sufficient supporting documentation to

demonstrate need and priority, and is well researched, strategic and

justified to avoid delays in the construction/purchase of equipment in the

event of grant approval.

Criterion 3 The application demonstrates that local consumer and carer

representatives are involved or consulted in regards to the project.

The evaluation criteria have been weighted to reflect their relative importance.

The weighting scale is:

Criterion Importance Weighting

Criterion 1 Critical 4

Criterion 2 Highly Important 3

Criterion 3 Highly Important 3

Proposals will be scored against the following scale:

Evaluation Score

Exceeds all aspects of the selection/evaluation criterion 10

Exceeds some aspects of selection/evaluation criterion (and meets all

other aspects of the selection/evaluation criterion)

6-9

Meets the selection criterion 5

Fails some aspects of the selection criterion 1-4

Fails all aspects of the selection criterion 0

Notification of successful / unsuccessful Proposals 7.3

Applicants will be notified in writing of their proposal/s outcome in regards to the funding grant as per the grant

funding timelines.

Successful applicants will need to confirm in writing that they accept the grant funding offer.

Unsuccessful applicants can get feedback on their proposals by emailing [email protected]


7

Reporting Requirements 7.4

Successful applicants will be required to submit Interim and Final Reports as part of the grant.

7.4.1 Interim Report

The Interim Report is due six months from the date that the agreement was signed. A template for the Interim

Report is included in Appendix 3. The purpose of the Report is to provide the Department of Health & Human

Services with an update on how the project is progressing and to highlight any implementation issues.

7.4.2 Final Report

A Final Report is due 15 days after completion or 12 months from the date that the agreement was signed.

A template for the Final Report is included in Appendix 4. The purpose of the Final Report is to provide the

Department of Health & Human Services with an overview of what work was undertaken, what was achieved and a

statement of expenditure for the grant.

7.4.3 End of grant

Following a review of the Final Report a formal acceptance of the final report will be sent.

For further information please email: [email protected] or phone Duncan Smart on 9096 8349.


8

8 Appendix 1: Eligible services

(i) Mental Health Facilities Renewal Grant

Albury Wodonga Health

Ballarat Health Services

Barwon Health

Bendigo Health

Goulburn Valley Health

Latrobe Regional Hospital

Mildura Base Hospital

Northeast Health Wangaratta

Southwest Healthcare

Alfred Health

Austin Health

Eastern Health

Melbourne Health

Mercy Health

Monash Health

Peninsula Health

Royal Children’s Hospital

St Vincent’s Hospital Victorian Institute of Forensic Mental Health (Forensicare)

(ii) Alcohol and Other Drug Facilities Renewal Grant

Anglicare Victoria Australian Community Support Organisation Ballarat & District Division Aboriginal Coop.

Ballarat Community Health

Banyule Community Health

Barwon Health

Barwon Youth (Baysa)

Bass Coast Health

Benalla & District Memorial Hospital

Bendigo & District Aboriginal Cooperative

Bendigo Community Health Services

Bendigo Health Care Group

Caraniche Pty Ltd

Castlemaine District Community Health

Central Bayside CHS

Central Gippsland Health Service Cobaw Community Health Services Limited

coHealth

Colac Area Health

Darebin CHS

Djerriwarrh Health Service

Drug Health Services (Western Health)

EACH Social and Community Services

Eastern Health

Echuca Regional health

Gateway Health

Gippsland & East Gippsland Aboriginal Cooperative

Gippsland Southern Health Service Glenelg Southern Grampians Drug Treatment Service, Portland District Health.

Good Sheppard Youth and Family Services

Goulburn Valley Health

Grampians Community Health Centre

Gunditjmara Aboriginal Cooperative

Inner South CHS (Prahran)

ISIS Primary Care Ltd.

Jesuit Social Services

Latrobe CHS

Mallee District Aboriginal Services Maroondah Addictions Recovery Project (MARP)

Maryborough District Health Service

MIND Australia

Mirabel Foundation Inc.

Monash Health Nexus Primary Health (formerly Mitchell CHS)

Ngwala Willumbong Cooperative Ltd

Njernda Aboriginal Cooperative

North East Health Wangaratta North Richmond Community Health Centre

Northern District Community Health

Odyssey House Victoria

Peninsula Health

Plenty Valley Community Health

Portland District Health

Primary Care Connect

Rumbalara Aboriginal Cooperative

Salvation Army Self Help Addiction Resource Centre (SHARC) South Eastern Melbourne Primary Health Network

South West Healthcare

St. Vincents Hospital Limited

Sunraysia CHS

Swan Hill District Health Services

TaskForce Alcohol & Drug Services

UnitingCare Ballarat Parish Mission

UnitingCare ReGen

Victorian Aids Council Victorian Aboriginal Health Service Vincentcare Victoria

Wathaurong Aboriginal Cooperative Ltd. Western Region Alcohol & Drug Centre (WRAD)

Winda-Mara Aboriginal Cooperative

Windana Drug & Alcohol Recovery Inc.

Youth Projects Inc.

Youth Substance Abuse Service (YSAS)

2

(iii) Mental Health Safety and Privacy Grant

ACSO

Albury Wodonga Health

Alfred Health

Austin Health

Ballarat Health

Barwon Health

cohealth

EACH

Eastern Health

Goulburn Valley health

Latrobe Regional Hospital

Melbourne Health

Mental Illness Fellowship

Mercy Health

Mind Australia

Monash Health

Neami

Peninsula Health

St Vincent’s Hospital

Wimmera Uniting Care

[Insert Health Service Name] [Insert Project Title] The Department of Health & Human Services Mental Health and Alcohol and Other Drug Services Facilities Renewal Grant 2015-16 Mental Health Safety and Privacy Grant 2015-16 1

9 Appendix 2: Application form

Submission requirements:

Due Date: 30 November 2015 – 4pm All organisations making submissions must complete this application form and include relevant supporting documentation (for example: cost plans; quotations).

Proposals must be received no later than 30 November 2015 – 4pm to be eligible for consideration. Proposals must be submitted by electronic copy only. Late, incomplete, facsimiled, hand delivered or Proposals delivered by mail will not be accepted.

All submissions must be submitted via electronic copy to [email protected]

All Proposals will receive a confirmation email upon receipt.

Proposals:

Services are required to denote the priority order of each application. Note: Only one property per application form.

Unless exceptional circumstances apply, proposals received after the specified time and date are deemed ineligible for consideration. Services that fail to meet the deadline as a result of IT failure will not be subject to any special considerations. To avoid such issues, services are encouraged to submit Proposals prior to the due date.

Please ensure:

The application form is submitted as a word document.

The CEO declaration is completed and submitted as a scanned electronic document (e.g. PDF); electronic signatures will not be accepted.

the file attachments have the following naming convention:

Service Name_Project Title_ Application no. 1 or 2.doc

Service Name_Project Title_CEO Declaration.pdf

Service Name_Project Title_Attachment 1.doc/pdf

(repeat as required for multiple attachments).

The Department of Health & Human Services reserves the right to request additional supporting information in relation to any application submitted to the Mental Health and Alcohol and Other Drug Services Capital Grant Program.

As this is a capped program not all eligible Proposals will be funded. To meet community expectations it is anticipated that funding will be used to support a broad range of communities and organisations.



Mental Health and Alcohol and Other Drug Services Capital Grant Program – (2015/16)

Please Note: All figures are to be shown exclusive of GST Grant Type: Please Circle only one

Mental Health Facilities Renewal Grant

Alcohol and Other Drug Facilities Renewal Grant

Mental Health Safety and Privacy Grant

Organisation name:

[Press F11 to move to next field] [Please complete all fields]

Project Title

Address Number Street Name Suburb State Postcode

Project Address VIC

Property owner

Land Type (i.e Crown or Freehold)

Service/s provided

TOTAL GRANT FUNDS requested. (Ex. GST)

CO-INVESTMENT (Ex. GST)

TOTAL PROJECT VALUE (Ex. GST)

$ $ $ Service Priority (select)

Priority 1 2 3 4 5 6 7

Services are required to denote the priority order of each grant proposal.


1. Organisation Details

Name Details

Legal Name

Trading Name

Australian Business Number (ABN):

Type of Organisation

Funded Service Provision type/s

Will entity/entities responsible for managing the delivery of the project also own and maintain the resulting assets? If not, name the entity/entities that will own and maintain the resulting assets.

2. Organisation Address

Address Number Street Name Suburb State Postcode

Street Address

VIC

Postal Address

[PO Box]

VIC

3. Authorised contact officers

Name Title Phone Preferred Contact

[Insert Name] Chief Executive Officer

[xx xxxx xxxx]

Email: @

Alternative Contact(s)

[Insert Name] [Insert Title] [xx xxxx xxxx]

Email: @

[Insert Name] [Insert Title] [xx xxxx xxxx]

Email: @


4. Service - Background

[Insert a brief description of the background of the service] [Please limit the response in this field to less than 250 words]

5. Project Summary

Provide a brief description of the project, please ensure that key deliverables are specified. This field will be used to provide summary reports on projects submitted. 250 words maximum.

6. Key Deliverables <Please ensure deliverables are made explicit (ie. to replace the roof, create 2 additional consult rooms, 2 additional beds, replace 2 window frames, replace the 10 outlet heating system etc>

7. Project Objectives

[Insert details of how the project supports current service and strategic planning objectives]

8. Project Activities

[Insert details outlining the scope of the proposed capital works project [Detailed descriptions of the works to be undertaken] For example: A minor capital works project should outline the following information as a minimum with additional relevant information provided as required: Key Deliverables (eg. extra consult rooms, m

2 of refurb/redevel, specific detail of what existing

conditions are and what will be delivered through the completion of the works). Size/dimensions of area to undertake works Current condition of building fabric and/or equipment Details of the capital works to be undertaken (i.e.minor refurb: paint work/ carpets/ furnishings, water, gas, electricity, heating, cooling or structural works, compliance to standards, disability access) What planning has been undertaken to date for the proposed capital works Please note; details in relation to proposed costs should be included in the cost plan template, located in section 22 of the application form. The cost plan must be completed for all projects.

9. Existing Conditions

[Outline the existing conditions]

10. Current status of planning/’readiness’ [Outline the current status of planning which will enable the project to meet proposed timelines]


11. Equipment Details (where applicable)

Equipment Intended Purpose Quote Price(s) (attach quote/s)

12. Project Rationale

[Insert details of rational of the proposed project. It should outline the action that needs to be considered at this time. This should capture the essence of why the project is required and the consequences of deferral.]

13. Project Urgency

[Insert details outlining the urgency of the project and implications of not undertaking the project. Please specifiy timelines if necesary]

14. Relationship to existing infrastructure

[Insert details of how the proposed capital project and/or equipment relates to the existing infrastructure of your facility]

15. Recent capital projects

Capital Project Details Funding Source Date Completed

[Insert brief details of recent capital projects undertaken at the project address in the past 1-10yrs]

16. Project Management & Capacity to undertake Project

[Insert details outlining the proposed project management of the proposal by your service. If the project management is to be undertaken by the service, please list resources and personnel]


17. Project Risk Management

All projects are required to complete the following table. Further lines should be included as required for any additional risks identified.

Risk Impact Likelihood Mitigation Strategy

Cost estimates are too low [High/Medium/Low]

[High/Medium/Low]

[Insert details]

Project delay [High/Medium/Low]

[High/Medium/Low]

[Insert details]

Costs are not included [High/Medium/Low]

[High/Medium/Low]

[Insert details]

Unacceptable operational disruption during implementation

[High/Medium/Low]

[High/Medium/Low]

[Insert details]

Delays in Authority approvals [High/Medium/Low]

[High/Medium/Low]

[Insert details]

Inadequate Programming or Program delays

[High/Medium/Low]

[High/Medium/Low]

[Insert details]

Cost problems – budgeting inadequacies

[High/Medium/Low]

[High/Medium/Low]

[Insert details]

[Other - Insert as required] [High/Medium/Low]

[High/Medium/Low]

[Insert details]

18. Project Timelines

Key Activity (Milestone) Key Date % Funding Distribution

[Insert activity/milestone] [Insert date] [% Funding]





Note: Services are requested to align % funding distribution with key activities/milestones as appropriate to the projects size and/or complexity.


19. Funding Proposal (GST Exclusive)

Funding Source 2015/16 ($m)

(ex. GST)

Mental Health and Alcohol and Other Drugs Renewal Grant

$

Organisation contribution $

Other co-contribution (Source: ) $

Mental Health Safety and Privacy Grant $

Organisation contribution $

Other co-contribution (Source: ) $

Total $

20. Consultation

It is expected that proposed projects have been developed in consultation with the relevant central office program area and/ or regional office of the Department of Health & Human Services. Please provide details of the consultation and/or endorsement of the proposed project, including details of a key contact(s), as follows:

[Insert details of consultation with the relevant program area and whether endorsement of the proposed proposal has been granted] [The area below is for completion of who within the Department of Health & Human Services you have discussed your proposed project with.

Key Department of Health & Human Services contact(s)

Name [Insert Name] Phone [Insert Phone number]

Title [Insert Title] Email @

DH [Insert Program Area/Reg Office Details]

Name [Insert Name] Phone [Insert Phone number]

Title [Insert Title & Program Area] Email @

DH [Insert Program Area/Reg Office Details]


21. Alignment with the grant program Assessment Criteria

Criterion One

The application demonstrates alignment with the aims of the grant program, the organisation's designated role, long-term strategy, and Victorian Government policy.

[Please ensure that under each criterion, you provide a succinct summary of how your project relates to the criterion]

Criterion Two

The application includes sufficient supporting documentation to demonstrate need and priority, and is well researched, strategic and justified to avoid delays in the construction/purchase of equipment in the event of grant approval.


Criterion Three

The application demonstrates that local consumer and carer representatives are involved or consulted in regards to the project.



22. Cost Summary There are two available costing summaries (a) and (b).

Cost plan (a) – is designed to be used for projects where a simple list of project costs is sufficient to outline the costs of the project (i.e. under $100,000).

Cost plan (b) – is designed to be used for minor capital works (i.e. refurbishment/redevelopment) where a detailed cost plan is more appropriate. This should be completed for any refurbishment/redevelopment projects.

Only one cost summary should be completed – please choose the most appropriate one for your project.

All costs should be shown exclusive of GST

Cost Plan (a)

Item Cost (ex GST)

Quote provided (Y/N)

Total


Cost Plan (b) To be completed for all projects which involve minor capital works including construction and/or refurbishment.

Cost Plan Summary - [Insert Project Title] – [XX/Month/Year] Based on [Insert Detail] Completed by: [Completed by:]

Functional Area Scope Area (m2 Rate ($/m2)

Total (ex GST) ($)

[Insert Detail - Eg. Kitchen]

[Insert Detail - Eg. bedroom]

[Insert Detail - Eg. Primary Care]

Total Building Costs

Project Specific Costs

Allowance for [Demolition]

Allowance for [Site Works]

Allowance for [Asbestos Removal]

Design Contingency %

Contract Contingency %

Cost Escalation Allowance to Tender at [Insert Date]

%

Total Construction Cost (at Insert Date)

Other Project Costs

[Specialist Equipment]

[IT and Communications]

[Consultants Fees]

[Sustainability & Infrastructure]

[Management Support]

[Relocation costs]

[Authority Charges]

Quotes provided

Total End Cost (at Insert Date)


CEO’s declaration 9.1

Service Project Title

[Insert Service] [Insert Project Title]

Declaration I [Insert CEO Full Name] Chief Executive Officer of [Insert SERVICE Name] , declare that the information provided on the Mental Health and Alcohol and Other Drugs Facilities Renewal/ Mental Health Safety and Privacy Grant proposal and supporting documentation is complete and correct and I confirm my understanding that: Where multiple projects are proposed by a service, these have been prioritised at the service level as indicated

in the proposal.

The proposed minor capital works: have not already commenced or completed construction; if relating to equipment, the equipment has not already been purchased, is not second hand equipment; and does not involve the payout of lease, currently leased or acquisition as part of a consumable contract.

No additional recurrent funding will be sought from the Department of Health & Human Services for the minor capital works proposal. Any recurrent funding implications in relation to the minor capital works will be absorbed by the service.

Any funds provided for the proposed minor capital works will not be used for any other purpose than that for which the specific grant is made. If the proposed funds are insufficient to complete the project, the Victorian Government is not obliged to provide additional funding.

If other contributing organisations fail to provide funding, the Victorian Government is not obliged to provide this funding. The Organisation will be responsible for organising the funding in question.

The minor capital works proposed are in accordance with National Construction Code (NCC)/Building Code of Australia (BCA) requirements, Australian Standards and Statutory Requirements and where applicable the Victorian Design Guidelines and include as far as practical the relevant sustainability guidelines. Equipment items (where applicable) must comply with relevant Australian Standards.

The equipment requiring replacement will be disposed of and this will be in accordance with appropriate standards. The service asset register will be updated for both the disposal of the old equipment and the acquisition of the replacement item.

In accordance with the standard service agreement terms and conditions, the service indemnifies the Department of Health & Human Services against a claim by any person for loss of or damage to property, death or personal injury or other financial loss, caused by the negligence of, or breach of, statutory duty by the service provider.

If funded, the service will show the minor capital works grant as having been committed and expended on capital works (and/or equipment where applicable), in accordance with the respective grant approvals, by inclusion in its annual report to the Department of Health & Human Services.

The funding request and associated costings/quotations are provided exclusive of GST.

CEO [Insert CEO Name] Phone [(xx) xxxx xxxx] Date [Insert Date] Mobile [xxxx xxx xxx] Signature Email [xxxx@xxxxx]

Note: This declaration must be signed by the CEO and emailed to the Department of Health & Human Services as a scanned copy of the original (eg. PDF). Electronic signatures will not be accepted.


10 Appendix 3 – Reporting - Interim Report Template

Name of organisation

Project name

Grant date

See your grant agreement / letter

Contact name

Contact telephone number

Contact email address

What activities have been undertaken since the

grant start date?

A statement confirming that works have been

completed in accordance with relevant

Victorian standards and guidelines.

When do you expect to complete this project?

Are there any issues which might impact this

completion date?

Please provide a description of any possible

media opportunities or event announcements.

Media contact

Photos of completed works

Grant Expenditure

Please provide a statement of expenditure to

demonstrate how the funds were spent.



11 Appendix 4 – Reporting - Final Report

Name of organisation

Project name

Grant date

See your grant agreement / letter

Contact name

Contact telephone number

Contact email address

What did you plan to achieve through the

project/ grant?

What activities were undertaken with this

grant?

Reporting achievements: What has the project/

grant helped you achieve? Can you describe

any outcomes or what difference has been

made?

Please provide a description of any possible media opportunities or event announcements.

Media contact

Grant Expenditure Please provide a statement of expenditure to

demonstrate how the funds were spent.


grant application guidelines - department of health, victoria · extended care units, residential...

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