3.4 7 project_proposal_template

Division Name
Unit Name
Project Name
FORM 2
FOR INTERNAL USE ONLY

Children Youth & Women’s Health Service
SA HEALTH
HEALTH PROJECT PROPOSAL

This Project Proposal is to be used by CYWHS staff to document proposed health promotion, health
information, community development and group-work activities. Projects may stand alone or
contribute to a broader Program Goal identified in a Program Plan (see Form 1 Program Plan).

PROJECT NAME:

PROGRAM NAME:

PROJECT CONTACT PERSON:
Position:
Location:
Phone:

Project Commencement Date:

Project Expected Completion:

Document Status :
Version Date Author Distributed to stakeholders
(Y/N)
1.0
2.0
3.0

Records Management:
List all existing files (if any) relating to this eg. Eat Well Be Active Admin File (CHP, South
Project Proposal and their location: Tce)

Please provide a Document Records
Management File Number (if available):

H:CHPPROGRAMSCYWHS, Health PromotionResource Developmentwebsite contentPage
updatesInternet2 Project Proposal template 200810.doc

Division Name
Unit Name
Project Name

1. Project Background
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________

2. Project Purpose (Goal)
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________

3. Applying a Health Equity Lens
Which population groups are most likely to be affected by this issue (be specific)?

What opportunities or capacities already exist within this area or group of people?

How do the target group define the problem or issue?

Is the target group for this project the same as the one who will benefit most? If not, why
not?

What are the conditions that enable or prevent the target group having a greater say in
the issue (participation)

How does this project intend to influence the mechanisms which maintain these health
inequities for this population group?

updatesInternet2 Project Proposal template 200810.doc 2

Division Name
Unit Name
Project Name
What might be the unintended consequences of implementing this project? (Do these
consequences pose a risk to the program or organisation?)

What sort of constraints might your project face in addressing this issue?

How will you know if this program has effectively reduced the inequities? (Consider this
in your Evaluation Plan)

4. Developing Project Objectives
Project Goal Project Objective Project Strategies

Reduce the risk of Increase awareness of parents Develop a placemat and recipe
physical health issues attending 6 month check at book with information
later in life through the identified clinic about 3 key
introduction of things about introducing solids Provide placemat and recipe
appropriate solid foods book with information at 6
at around 6 months month check

1.

2.

The information in this table will later automatically appear in the evaluation section of this
Project Proposal.

5. Gathering Evidence
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________


Division Name
Unit Name
Project Name
________________________________________________________________________
________________________________________________________________________

6. Identifying Partnerships and Community Participation
Information giving: Staff decide what the stakeholder needs to know and communicate
it to them usually in written form
Information Staff seek information, opinions, and views from the stakeholder
seeking:
Consultation: Stakeholder views and experiences are incorporated into decision
making about health service delivery
Partnership: Decisions are made jointly by stakeholders and CYWHS.
Partnership relies on common goals, mutual values and respect.
Decision makers Some or all of the decision making authority (including control over
the resources) rests with these stakeholders

STAKEHOLDER ROLE LEVEL OF PARTICIPATION
These can be listed in two
groups
1. Those involved in program
operations eg.sponsors,
collaborators, partners, funding
bodies, managers and staff

Eg. Eat Well SA Collaborator Partnership
1.
2.
3.
4.
5.

2. Those served or affected by
the program eg. consumers,
advocacy groups, professional
associations, and related or
competing agencies or services

Eg. Parents Consumer Information seeking
1.
2.
3.
4.
5.


Division Name
Unit Name
Project Name

7. Evaluation Plan
Will the results or evaluation learnings from your project will be shared?

Yes No

If they will be shared, how might that be? Eg. Reports, journal articles etc.

*Whether an external evaluation is being carried out or not a Project Evaluation Plan
should be completed.

8. Project Influence
How many people is your project likely to reach?

9. Project Costs
Give the approximate FTE required for this project & over what period of time
eg. ASO4 x 0.6FTE for 6 months from January 2010

Give an estimate of anticipated project costs for goods and services? If your project is
likely to require a goods and services budget of more than $5,000, please complete a
more detailed Annual Budget Plan (LINK).

Will external contractors be engaged to assist with delivery or evaluation?
[Link to Supply & Procurement processes]

Is the project likely to generate revenue from external sources?

10. Project Milestones
List the dates you expect to reach significant milestones in your project. Include project
review dates.

Milestone Timeframe
Canvas stakeholder views on the issue
Develop Project Proposal


Division Name
Unit Name
Project Name
Develop Communications Plan (if required)
Commence Ethics Approval Process (if required)
Commence formal consultation and engagement processes
Submit first project review (as needed)
Complete consultation
Submit second project review (as needed)
Commence implementation
Complete evaluation
Submit final project report & evaluation results

*Before you go any further, have you contacted Communications and Public Relations to brief
them on your proposed project? If not, please do so now on 8161 6173.

You are now ready to forward your completed PROJECT
PROPOSAL to your Line Manager for acceptance.


Division Name
Unit Name
Project Name

ACCEPTANCE (Management Use Only)
DATE RECEIVED:

PROJECT ACCEPTED
PROJECT NOT ACCEPTED. Why?
_______________________________________________________________________
_______________________________________________________________________

Accepted with the following changes
_______________________________________________________________________
_______________________________________________________________________

Person accepting project:
Signature: ____________________________ Date approved: ________________
Name:________________________________ Position: ______________________

This project is to be reviewed on: _________________________

Please proceed with the following documentation:

Implementation Plan (Form 2A)
More detailed Annual Budget Plan (Form 2B)
CYWHS Communication Plan
CYWHS Ethics Approval
Procurement Plan
Printed Health Information Procedure
Other

Please use the Amendment and Review Forms to document any changes to your project as
they occur.


3.4 7 project_proposal_template

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