12.07.2015 Views

Rota Design for 2009 - North Western Deanery

Rota Design for 2009 - North Western Deanery

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Hours Breach ReportNameGradeDepartmentBleep numberE mailConsultantDay and dateShift timesShift typeNormal working dayLong dayNight shiftOther (specify)Type of breach(tick as many as applicable)Lunch breakEarly evening break (<strong>for</strong> doctors on long days)Night shift break (early 20:00 to 02:00)Night shift break (late 02:00 to 08:00)Was the failure to take a natural break voluntary? Yes NoWho did you notify?NameWard sisterDirectorate managerConsultantSpRSHOWhy was it not possible to take a break?(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 taken59

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