The Chemist Professionals (Inquiry) Regulations, 2019

1. If you are dissatisfied with service or you suspect misconduct or incapacity of a chemist professional or violation of professional conduct please fill in this form.

2. Enter the information requested in each section of the complaint form. If more than one chemist professional is being reported a separate form should be used for each chemist professional being reported.

3. Anonymous complaints are accepted and will be investigated if sufficient identification information for the chemist professional is submitted. It must be able to properly identify the chemist professional in question before inquiry can proceed.

4. All complainants who identify themselves with contact information will be notified in writing as to the final disposition of the complaint. If a complaint is received anonymously the Council will not reveal the final outcome to interested callers. If you have questions regarding how to fill in and submit the complaint form you may contact the Registrar or any person acting in that behalf for further details.

5. Particulars of Complainant Name of the complainant………………………………………………….…… Physical Address………………………………………………………………… Name of the facility/company ................................................................................ Telephone No./Mobile No.………………….………..………............................. Email address ........................................................................................................ Particulars of the Chemist professional Full Name of the chemist professional……………………………………….…… Chemist professional’s Position/designation……………………………….…….. Name of the Employer……………………………………………………….…… Name of the facility/company/institution..……………..…………………….…… 15 GN NO. 580 (contd) Chemist Professionals (Inquiry) Area of practice chemist professional worked at time of event/incident ………… Time of the incident……………………………………………………………….. Reported to the employer…………………………………………………..……… If yes, to who was it reported? ................................................................................ Dates and time reported……………………………………..…………………..… Actions taken by employer, if any, state…………………..………………………. What is your relationship to this chemist professional? ………………………….. Has this matter been reported to the Police? ……………………………………... Details of the Complaint You may attach copies of relevant documents if available (use additional sheets if necessary): (Give specifics including what happened, the date, place and time of occurrence) …………………………………………………………………………………… …………………………………………………………………………………… …………………………………………………………………………………… …………………………………………………………………………………… …………………………………………………………………………………… …………………………………………………………………………………… …………………………………………………………………………………… …………………………………………………………………………………… …………………………………………………………………………………… List of Witnesses List names, addresses and telephone numbers of other people who knows this possible violation, …………………………………………………………………………………… …………………………………………………………………………………… …………………………………………………………………………………… Declaration: I ............................................................... declare that, the given information is true and correct to the best of my knowledge and understanding. Signature.............................. Date...................................... FOR OFFICIAL USE Received from (name)……designation…….contacts (telephone No./Mobile No.… Dates and time received……………...................signature…………………. Received by………………………………..position/designation……………. Comments/advice if any……………………………………………………….. 16 GN NO. 580 (contd) Chemist Professionals (Inquiry) Actions taken…………………………………………………………………… …………………………………………………………………………………. Dates and time………………….signature……………….. stamp …………….. 17 GN NO. 580 (contd) Chemist Professionals (Inquiry) _______________ THIRD SCHEDULE _______________ (Made under regulation 5(1)(b)) _________________ THE UNITED REPUBLIC OF TANZANIA MINISTRY OF HEALTH, COMMUNITY DEVELOPMENT, GENDER, ELDERLY AND CHILDREN Address............. Date:........... RE: NOTICE OF PRELIMINARY EXAMINATION On behalf of the Chairman of the Chemist Professional Council, I hereby give you notice that information and evidence have been received by the Council, from which it is alleged that between dates .............. to.............., being a registered, enrolled or enlisted misconduct committed Chemist on,……………………………………......................................................................... Professional professional you a ...................................................................................................................................... ...................................................................................................................................... ...................................................................................................................................... ...................................................................................................................................... In relation to the facts so alleged, I undertake to hold Preliminary Examination in respect thereof. You are therefore required to answer in writing the above allegations revealed against you and attach therewith any document or evidence, which you intend to produce as defence thereto. You are further required to avail your answers to the office of the Registrar within seven (7) days from the date of receipt of this notice. 18 GN NO. 580 (contd) Chemist Professionals (Inquiry) Note that, failure to respond as herein required shall warrant the Council to proceed with the inquiry against you in your absence. REGISTRAR 19 GN NO. 580 (contd) Chemist Professionals (Inquiry) ________________ FOURTH SCHEDULE _______________ (Made under regulation 8(3)) _______________ THE UNITED REPUBLIC OF TANZANIA MINISTRY OF HEALTH, COMMUNITY DEVELOPMENT, GENDER, ELDERLY AND CHILDREN Name and Address of Respondent……. ............................................................... ............................................................... Date……... RE: NOTICE OF DATE OF HEARING On behalf of the Council, I .................................................serve you a notice (that information by been …………………………………. (name/company/institution) which the complainant makes various allegations against you. the Council evidence before have laid and the performing The allegations and charges indicates that on the ……… day of ……..………. you were seen/observed following……………………(offences/misconduct) at……………………namely ……...……………(place) and I am directed by the Council to of ………………at………………………………. (venue and place), a meeting of the Council will be held ……………a.m./p.m. to consider the above mentioned charge or charges against you. ………day notice give you that the on Your hereby requested to appear before the Council at the above named place and time. In case you fail to appear in person or by your legal representative the Council may proceed to determine the matter in your absence. You may wish to bring your witnesses and documents you intend to rely upon in support of your case. ………………………… REGISTRAR 20 Chemist Professionals (Inquiry) GN NO. 580 (contd) Signature............................................ Stamp................................ Copy to be served: …………………………………… …………………………………… Date................................. Dodoma, …………………, 2019 Minister for Health, Community Development, UMMY A. MWALIMU Gender, Elderly and Children 21