Agency Approval Form

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					Royal Children’s Hospital Agency Approval Form – Nursing Services
Process for approval: 1. Verbal approval – In Hours Critical Care: Ambulatory: Surgical: Medical: Executive Director, Acute Operations & Org. Improvement Director, Ambulatory Services Director, Clinical Operations, Division of Surgery Director, Clinical Operations, Division of Medicine Mobile: Ext. Ext. Ext. 0408 548 770 4828 Pager: 4026 5057 Pager: 5057 5572 Pager: 5572

2. Verbal approval – After Hours After hours Coordinator Pager 4000

3. Following verbal approval, the Agency Approval Form MUST BE completed and faxed to the Roster Service Office on Ext 4035. 4. Agency staff WILL NOT be booked WITHOUT approval

Agency will be used in accordance with the Nurses (Victorian Public Health Sector) Multiple Business Agreement 2007 – 2011 Unit: Cost Centre: REQUEST FOR Agency – Division 1 Agency – Division 2 Agency – PCA Comment: Tick Approp. REASON FOR REQUEST Sick Leave Replacement Staffing Deficit Tick Approp. Date: / / Time: am/pm

AUM:

__________________________________________ Nurse Unit Manager ___________________________________ Signature Signature _____________________________________________________ (Operations Mgr/After hours Co-ordinator) Signature __________________________________ Date: / / Time: am / pm

Approved By: Name:

NOTE: Please ensure all sections of this approval form are completed prior to faxing.