Take 2 Use this form below to submit a nursing process or practice that needs to be reviewed that could improve safety and patient outcomes. Take Two Submission Form Employee Name: (optional) First Last Employee Workday ID: (optional) Employee Email: (optional) Unit/Area/Clinic:(Required) Supervisor/CS:(Required) CS (Clinical Specialist): Current Process/Practice(Required)Briefly describe the current process/practice that you want reviewed.Concerns about current process/practice:(Required)What are your concerns about the current process/practice?Impact:(Required)Do you have an example of the impact of this process/practice? (patient or nurse story)Department(s) Involved:(Required)What department(s) will be involved with this change? (Informatics, Pharmacy, Supply Chain, EVS, Agility, Interpreting Services, etc.)Policy # Affected:Please enter the policy number and name pertaining to the suggested Take Two suggestion. If you need help finding the policy, please talk with your CS or your CSM.