Switching Shift Form

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Form to inform department of switch in shift > 8 hours.

DO NOT FILL OUT THIS FORM UNLESS YOU HAVE OBTAINED PERMISSION FROM ALL SENIORS.
This is NOT a request form.
This is just to have a record kept in the office for switches that do not appear on the rota.
This is in case there is medicolegal action in the future and there is need to identify who actually worked on a specific day.

* Indicates required field

Name *

First

Last

Security Code *

Name of person switching with *

First

Last

Has this person agreed to a switch *

Yes No

Date switching from *

Month *

Year *

Location working *

AICU OT MHWH

Consultant on call on date switching from *

Has consultant agreed? *

Yes No

Date switching to *

Month *

Year *

Consultant on call on date switching to *

Has consultant agreed? *

Yes No

For house officers, please indicate the registrars on duty and state if they have been informed.

Please Fill in Details *

Consultant on for the week (AICU only) *

Has consultant agreed? *

Yes No

If your arrangement is affecting how you work on a list, have you made arrangements to have your list covered? If so, please indicate who is covering your list and please state if you have discussed with the consultant (and registrar) and whether they have agreed with your arrangement.

Details *

Submit

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Home
- Feedback
Anaesthesia & AICU Projects
PICU Projects
- PICU Crash Sheet
- Bed Booking Form: PICU
Other Projects
- CMJ-test
Brewing Creations
- Mead-Semisweet
PDFs
Private Documents