Residential Request for Staff Form (QLD)
01.07.2024
Request date/time - no need to fill out this section it's automatic
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Date
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Hour
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Minutes
AM
PM
AM/PM Option
Referring Agency
*
Office/Branch Name and Address
*
Contact Person Name
*
Contact Person Number
*
Contact Person Email Address
*
Contact Person Name For Invoices
*
Contact Person Number For Invoices
*
Contact Person Email Address For Invoices
*
Child Safety Service Centre Manager Name- If known
Child Safety Service Centre Manager Email
Child Safety Service Centre Manager Contact Number
Address of Residential Facility
*
This will be the name of the Roster within the database
Date and Time of Shift/s
*
Is a purchase order required for payment of invoice? If so, please provide the purchase order number below
*
Yes
No
Other
Do you require a quote for this support request?
*
Yes
No
Requirements of Worker
*
Category 1 (Entry Level Experience)
Category 2 (Experience)
Category 3 (Very Experienced)
Category 4 (Professional)
Number of Workers on each shift
*
One worker model
Two worker model
Three worker model
Other
Minimum Requirements of ProCare Australia Youth Workers
*
Certificate IV in Youth Work or relevant field
Diploma in Youth Work or relevant field
First Aid and CPR
Hope and Healing Training
Current Blue Card
Current Drivers Licence
Current Comprehensive Car Insurance
NDIS Worker Screening Check
National Police Clearance
TCI
LCS clearance
Other
Is COVID19 Vaccination required for all attending ProCare Australia staff?
*
Yes
No
Preferred but not essential
Are Case Notes required to be completed for an additional charge? *If case notes are completed on shift there is no additional charge
*
Rows
Not Required
15 Minutes
30 Minutes
Case Notes
Full Brief for the Shift
*
When will Induction occur? *If Induction is a requirement
Children/Young Person in the Residential
Known Safety Concerns/Risks for each Young Person in the property
*
Is there a current Positive Behaviour Support Plan for each Young Person, available within the residential?
*
Yes
No
Please provide details of the PBS and where our worker can find the information:
Likes and Dislikes for each Young Person in the property
*
Any other information that would assist a ProCare Australia Youth Worker to meet the needs of the Young Person/s
Pre-Approved Allowances (if required)
*
Organisational Emergency/OnCall Contact Number
*
Organisational Emergency/OnCall Contact Name
*
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: