Agency Request form
This process sets out the steps every manager must follow before booking external agency staff. Following this process consistently will help reduce agency spend, improve continuity of care, and support workforce planning across our homes. Agency should only be used as a last resort, after all internal options have been exhausted. Every booking must be authorised and recorded so that patterns can be identified and addressed.
Home Name
*
Please Select
Croft Lodge
Estuary View
Beacon House
Windward House
Willow House
Date of request
*
/
Day
/
Month
Year
2 digit day, 2 digit month, 4 digit year
Date
Is this request within the first 2 agency shifts in the current 14-day period?
*
Please Select
Yes
No
Not sure
Internal Exhaustion Checks
Attempted to offer the shift as overtime to available staff
*
Done
Contacted all bank or casual employees
*
Done
Staff on annual leave asked to swap or move holiday
*
Done
Consideration of rota or role restructuring
*
Done
Considered cover from a sister home
*
Done
Summary of all internal options attempted and outcomes
*
Risk and Agency Decision
Is the gap a genuine risk to resident safety or regulatory compliance?
*
Please Select
Yes
No
Unsure
Can the shift be covered at reduced capacity without compromising care?
*
Please Select
Yes
No
Unsure
Is the role one that agency staff are suitably qualified and able to cover?
*
Please Select
Yes
No
Unsure
Does the gap need to be filled by agency?
*
Please Select
Yes – proceed to authorisation
No – manage internally and do not book agency
Booking and Compliance Records
Agency name
*
Shift date
*
/
Day
/
Month
Year
2 digit day, 2 digit month, 4 digit year
Date
Shift time
*
Role required
*
Shift date
/
Day
/
Month
Year
2 digit day, 2 digit month, 4 digit year
Date
Shift time
Role required
Shift date
/
Day
/
Month
Year
2 digit day, 2 digit month, 4 digit year
Date
Shift time
Role required
I confirm I will complete the Agency Worker Induction Form for each agency worker before shift
*
Yes
Submit
Agency authorisation section
Operations Manager
Authorising manager name
Is the agency request approved?
Please Select
Yes
No
Date authorisation given
/
Day
/
Month
Year
2 digit day, 2 digit month, 4 digit year
Date
Submit
Should be Empty: