General Request for Staff Form (QLD)
Disability and Mental Health Support- updated 01.07.2024
Request date/time - no need to fill out this section it's automatic
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Minutes
AM
PM
AM/PM Option
Referring Agency
*
Office/Branch Name and Address
Contact Person Name
Contact Person Email Address
Contact Person Number
Requirements of Worker
Category 1 (Entry Level Experience)
Category 2 (Experienced)
Category 3 (Very Experienced)
Category 4 (Professional)
Date and Time of Shift
Shift Address
Job Brief
Does the assigned ProCare Australia Worker require an NDIS Check Clearance to complete the request?
*
Yes
No
Please upload your COVID19 Policy and Procedure to be added to the roster provided to attending staff.
Browse Files
COVID19 Policy and Procedure
Cancel
of
Are Case Notes required to be completed?
Rows
Not Required
15 Minutes
30 Minutes
Case Notes
Client Information
Required Probity
*
Blue Card - Working with Children Check
NDIS Worker Clearance - Disability
National Police Check
First Aid
CPR
Certificate IV minimum qualification
Diploma minimum qualification
Bachelor Degree or higher minimum qualification
NDIS Check Clearance
Diagnosis | Behaviours | Experience Required
Safety Concerns
Pre-Approved Allowances (if required)
Authorisation of shift Approval (If you require time sheets to be signed off after the shift please provide details below)
Rows
Name
Email
Position
Contact Number
Approver
Submit
Should be Empty: