Induction Form

Staff Nursing Induction Form

This form is to be completed by all Staff Nursing agency members at the start of their first shift in any Nursing, Residential Home or Care Facility, if possible, with the Nurse-in-Charge. Complete all sections relevant to your grade, if for any reason this form cannot be completed on arrival to your scheduled shift, you MUST call the office report to the office immediately.
Staff Nursing Agency Member*

First NameLast Name
Grade
Date

DayMonthYear
Date
Name of Home*
Name of employee providing induction

Emergency Procedures
Fire PanelsEmergency ExitsEvacuation procedureAssembly PointEmergency contacts & phone numbersResuscitation equiptmentTelephone # out or code for front door and any other codes

Layout of Home
Linen storePad storeToilets/BathroomsSluicesDining roomsBuzzer panelAll staff areas
Other areas specific to your establishment

Moving and Handling
HoistStanding hoistSlingsBath seatsSpare battery packsCharging stationsSlide sheets
Anything practices or equipment not list above please specify below
If you have demonstrated use of any unfamiliar equipment please specify below

Registered Nurses - Refer to NMC guidelines for the administration of medicines & record keeping

All staff refer to Staff Nursing Handbook for all Compnay policies
Signature of agency member

Clear
Should be Empty:

Staff Nursing Induction Form