12.07.2015 Views

Rota Design for 2009 - North Western Deanery

Rota Design for 2009 - North Western Deanery

Rota Design for 2009 - North Western Deanery

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Hours Breach ReportNameGradeDepartmentBleep numberE mailConsultantDayDateWorking patternFull shiftOn call rotaNo on callOther (specify)Shift typeNormal working dayLong dayNight shiftOther (specify)Type of breach(tick as many as applicable)Early start (than agreed start time)Late finish (than agreed finish time)Was the breach voluntary? Yes NoWho did you notify?NameWard sisterDirectorate managerConsultantSpRSHOWhy did you start earlier/finish laterthan your agreed start/finish time?(this section must be completed in detail)What action was taken by the person you notified?Please <strong>for</strong>ward this <strong>for</strong>m to your medical staffing department within 24 hours of your failureto take a natural break.For office use Referred to DGM DD DM CD Other(specify below)Other action taken58

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