Charisma SPD – Tech Onboarding Checklist (Temp Staffing)

1
Tech Full Name* This field is required.
First Name
Last Name
2
Role/Discipline* This field is required.
Please Select
Please Select
SPD Technician (Certified – CRCST)
SPD Technician (Non-Certified)
Lead/Preceptor SPD Technician
3
Start Date* This field is required.
Date
Month
Day
Year
4
Facility Name* This field is required.
5
Facility Location
6
Recruiter/Coordinator Name* This field is required.
7
Recruiter Email
example@example.com
8
Reviewer Name (Compliance/Onboarding)* This field is required.
9
Identity & Work Eligibility Checklist
Status
Notes/Evidence
Government-issued photo ID (front/back)
Completed
Pending
N/A
Row 0, Column 0
Row 0, Column 1
I-9 work authorization documents verified
Completed
Pending
N/A
Row 1, Column 0
Row 1, Column 1
SSN collected securely / payroll set-up completed
Completed
Pending
N/A
Row 2, Column 0
Row 2, Column 1
Current address + emergency contact on file
Completed
Pending
N/A
Row 3, Column 0
Row 3, Column 1
Government-issued photo ID (front/back)
I-9 work authorization documents verified
SSN collected securely / payroll set-up completed
Current address + emergency contact on file
Status
Completed
Pending
N/A
Row 0, Column 0
Notes/Evidence
Row 0, Column 1
Status
Completed
Pending
N/A
Row 1, Column 0
Notes/Evidence
Row 1, Column 1
Status
Completed
Pending
N/A
Row 2, Column 0
Notes/Evidence
Row 2, Column 1
Status
Completed
Pending
N/A
Row 3, Column 0
Notes/Evidence
Row 3, Column 1
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10
Medical & Occupational Health Checklist
Status
Notes/Evidence
Medical clearance completed (fitness for duty)
Completed
Pending
N/A
Row 0, Column 0
Row 0, Column 1
Immunization record/titers (facility-required)
Completed
Pending
N/A
Row 1, Column 0
Row 1, Column 1
TB screening current; CXR if prior positive
Completed
Pending
N/A
Row 2, Column 0
Row 2, Column 1
N95 medical clearance / fit test (if required)
Completed
Pending
N/A
Row 3, Column 0
Row 3, Column 1
Medical clearance completed (fitness for duty)
Immunization record/titers (facility-required)
TB screening current; CXR if prior positive
N95 medical clearance / fit test (if required)
Status
Completed
Pending
N/A
Row 0, Column 0
Notes/Evidence
Row 0, Column 1
Status
Completed
Pending
N/A
Row 1, Column 0
Notes/Evidence
Row 1, Column 1
Status
Completed
Pending
N/A
Row 2, Column 0
Notes/Evidence
Row 2, Column 1
Status
Completed
Pending
N/A
Row 3, Column 0
Notes/Evidence
Row 3, Column 1
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11
Background & Compliance Checklist
Status
Notes/Evidence
OIG LEIE exclusion check (clear)
Completed
Pending
N/A
Row 0, Column 0
Row 0, Column 1
NY OMIG exclusion check (clear)
Completed
Pending
N/A
Row 1, Column 0
Row 1, Column 1
SAM exclusions check (clear)
Completed
Pending
N/A
Row 2, Column 0
Row 2, Column 1
Criminal background check completed (as permitted)
Completed
Pending
N/A
Row 3, Column 0
Row 3, Column 1
Drug screen completed (if required)
Completed
Pending
N/A
Row 4, Column 0
Row 4, Column 1
Fingerprinting completed (if required)
Completed
Pending
N/A
Row 5, Column 0
Row 5, Column 1
OIG LEIE exclusion check (clear)
NY OMIG exclusion check (clear)
SAM exclusions check (clear)
Criminal background check completed (as permitted)
Drug screen completed (if required)
Fingerprinting completed (if required)
Status
Completed
Pending
N/A
Row 0, Column 0
Notes/Evidence
Row 0, Column 1
Status
Completed
Pending
N/A
Row 1, Column 0
Notes/Evidence
Row 1, Column 1
Status
Completed
Pending
N/A
Row 2, Column 0
Notes/Evidence
Row 2, Column 1
Status
Completed
Pending
N/A
Row 3, Column 0
Notes/Evidence
Row 3, Column 1
Status
Completed
Pending
N/A
Row 4, Column 0
Notes/Evidence
Row 4, Column 1
Status
Completed
Pending
N/A
Row 5, Column 0
Notes/Evidence
Row 5, Column 1
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12
Training & Attestations Checklist
Status
Notes/Evidence
HIPAA/confidentiality training + signed agreement
Completed
Pending
N/A
Row 0, Column 0
Row 0, Column 1
Harassment/discrimination training
Completed
Pending
N/A
Row 1, Column 0
Row 1, Column 1
Infection prevention basics
Completed
Pending
N/A
Row 2, Column 0
Row 2, Column 1
Bloodborne pathogens (annual)
Completed
Pending
N/A
Row 3, Column 0
Row 3, Column 1
PPE training
Completed
Pending
N/A
Row 4, Column 0
Row 4, Column 1
HazCom/SDS training
Completed
Pending
N/A
Row 5, Column 0
Row 5, Column 1
Safety: exposure + incident reporting training
Completed
Pending
N/A
Row 6, Column 0
Row 6, Column 1
HIPAA/confidentiality training + signed agreement
Harassment/discrimination training
Infection prevention basics
Bloodborne pathogens (annual)
PPE training
HazCom/SDS training
Safety: exposure + incident reporting training
Status
Completed
Pending
N/A
Row 0, Column 0
Notes/Evidence
Row 0, Column 1
Status
Completed
Pending
N/A
Row 1, Column 0
Notes/Evidence
Row 1, Column 1
Status
Completed
Pending
N/A
Row 2, Column 0
Notes/Evidence
Row 2, Column 1
Status
Completed
Pending
N/A
Row 3, Column 0
Notes/Evidence
Row 3, Column 1
Status
Completed
Pending
N/A
Row 4, Column 0
Notes/Evidence
Row 4, Column 1
Status
Completed
Pending
N/A
Row 5, Column 0
Notes/Evidence
Row 5, Column 1
Status
Completed
Pending
N/A
Row 6, Column 0
Notes/Evidence
Row 6, Column 1
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13
Facility Orientation & Access Checklist
Status
Notes/Evidence
Facility orientation completed (policies + workflow)
Completed
Pending
N/A
Row 0, Column 0
Row 0, Column 1
Facility policies acknowledgment signed (attendance, badge, phone)
Completed
Pending
N/A
Row 1, Column 0
Row 1, Column 1
Badge/ID issued; access granted
Completed
Pending
N/A
Row 2, Column 0
Row 2, Column 1
Timekeeping method confirmed (Kronos/UKG/badge/paper)
Completed
Pending
N/A
Row 3, Column 0
Row 3, Column 1
Uniform/scrub color, PPE, parking confirmed
Completed
Pending
N/A
Row 4, Column 0
Row 4, Column 1
Facility orientation completed (policies + workflow)
Facility policies acknowledgment signed (attendance, badge, phone)
Badge/ID issued; access granted
Timekeeping method confirmed (Kronos/UKG/badge/paper)
Uniform/scrub color, PPE, parking confirmed
Status
Completed
Pending
N/A
Row 0, Column 0
Notes/Evidence
Row 0, Column 1
Status
Completed
Pending
N/A
Row 1, Column 0
Notes/Evidence
Row 1, Column 1
Status
Completed
Pending
N/A
Row 2, Column 0
Notes/Evidence
Row 2, Column 1
Status
Completed
Pending
N/A
Row 3, Column 0
Notes/Evidence
Row 3, Column 1
Status
Completed
Pending
N/A
Row 4, Column 0
Notes/Evidence
Row 4, Column 1
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14
Assignment Confirmation Checklist
Status
Notes/Evidence
SOW/assignment details confirmed (shift, unit, rate)
Completed
Pending
N/A
Row 0, Column 0
Row 0, Column 1
Call-out procedure reviewed; contact numbers provided
Completed
Pending
N/A
Row 1, Column 0
Row 1, Column 1
Competency/skills checklist completed (if required)
Completed
Pending
N/A
Row 2, Column 0
Row 2, Column 1
SOW/assignment details confirmed (shift, unit, rate)
Call-out procedure reviewed; contact numbers provided
Competency/skills checklist completed (if required)
Status
Completed
Pending
N/A
Row 0, Column 0
Notes/Evidence
Row 0, Column 1
Status
Completed
Pending
N/A
Row 1, Column 0
Notes/Evidence
Row 1, Column 1
Status
Completed
Pending
N/A
Row 2, Column 0
Notes/Evidence
Row 2, Column 1
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15
Clearance Decision* This field is required.
Cleared for assignment
Cleared with restrictions (attach)
Not cleared
16
Restrictions Details (if Cleared with restrictions)* This field is required.
17
Not Cleared Reason (if Not cleared)* This field is required.
18
Evidence Uploads (PDF/JPG/PNG)
Drag and drop files here
Select files to upload
Max. file size: 10.0MB
Cancelof
19
I certify the onboarding items above have been verified and documented according to Charisma SPD policy and facility requirements.* This field is required.
20
Reviewer Signature* This field is required.
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21
Reviewer Date* This field is required.
Date
Month
Day
Year
22
I acknowledge I received onboarding instructions and understand I must comply with facility policies.* This field is required.
I acknowledge
23
Tech Signature
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