General Request for Staff Form- not OOHC (QLD)
Updated 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 Email Address
Child Safety Service Centre Manager Name
Child Safety Service Centre Manager Email
Child Safety Service Centre Manager Contact Number
Requirements of Worker
*
Category 1 (Entry Level Experience)
Category 2 (Experienced)
Category 3 Very Experienced)
Category 4 (Professional)
Is COVID 19 Vaccination required for the staff providing support?
Yes
No
Is LCS clearance with your organisation, required for the staff providing support?
Yes
No
Date and Time of Shift
Job Brief
*
Does the assigned ProCare Australia worker require an NDIS Check Clearance to complete the shift requested?
Yes
No
Approved Attendee/s (if required)
Rows
Name One
Name Two
Name Three
Name Four
Attendee/s Name
Relationship Status (parent/participant/family member/care provider/client)
Are Case Notes required to be completed?
Rows
Not Required
15 Minutes
30 Minutes
Case Notes
Participant/Clients Information
Child Safety Seat- if required
Forward Facing Infant
Booster Seat
Rear Facing Infant
Not Required
Known Safety Concerns or Risk Factors that may impact the requirements of the shift
Primary Carer Name- if required
Primary Carer Address or Address of Participant/Client
Primary Carer or Participant/Client Contact Number
Pre-Approved Allowances (if required)
Authorisation of shift Approval (contact for time sheets approval)
Rows
Name
Email
Position
Contact Number
Approver
Submit
Should be Empty: