This form is used by Manitoba Health, Seniors and Active Living (the department) staff during a site visit to the addictions agencies which are supported in whole or in part by grants from the department. The form is completed by staff during the visit and outcomes reported to the Executive Director responsible.
This form is applicable toญญญญญญญญญญญ all Manitoba addictions agencies which receive grant funding through continuing service agreements with the department; agreement to submit to site visits by department staff is a condition of the agreements. The form is not public-facing.
This form will be processed by the department of Health, Seniors and Active Living.