Section 1 — Provider organisation details
Key contacts
Section 2 — Site where cover is required
If different from the registered office, please provide the address of the home, unit, or service where our staff will be working.
Section 3 — Staffing requirement
Roles required
Shift pattern
Section 4 — Skills, training and specialisms required
Tick all the competencies our staff must have to work safely at your service. We will only deploy staff whose training and verified experience match what you tick.
Section 5 — Service user information (anonymised)
Please do not include names or identifying details. Initials only where helpful.
Section 6 — Risk assessment, induction & site information
CIW and CQC require that agency staff receive a documented induction and access to relevant risk assessments before commencing duties.
Section 7 — Commercial terms
Section 8 — Compliance, safeguarding & information sharing
Quality Staffing Care confirms that every worker we deploy has:
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A current Enhanced DBS check (subscribed to the Update Service where appropriate)
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Verified right to work in the UK
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Two satisfactory professional references covering at least the last three years
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Up-to-date mandatory training, including safeguarding, manual handling, infection control and medication where required
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Where applicable, valid registration with Social Care Wales or the NMC
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A signed code of conduct and confidentiality agreement
By submitting this form you confirm that:
Section 9 — Authorisation
The undersigned confirms they are authorised to commit the organisation to the booking detailed in this form.
