Expression of Interest - Covid Vaccination

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Please complete this form if you would be interested and available to assist with the delivery of Covid Vaccines From the Haringey Covid Sites:
1) Morris House Group Practice, 239 Lordship Lane, London, N17 6AA.
2) Bounds Green Group Practice, Gordon Road, N11 2PF

Roles and responsibilities will be blended and include vaccinating (if clinically qualifies) and administrative work as well as patient direction and signposting. Some work may take place outdoors or involve supporting home visits.

In completing this form you consent to your information being used by Haringey Covid services for the purposes of supporting vaccine delivery.

Clinic times will be between 0800-2000, seven days a week. You will be asked to work between 8-12 hours on days.

Full Name *

First and last name

Home Address *

Mobile number *

Email: (NHS, University or Professional Email preferable over personal email) *

Name of current employer/university if relevant. *

Current role or post or job title if relevant *

If a student: Current stage of training

Year 1 student

Year 2 student

Year 3 student

Year 4 student

Year 5 student

Other:

Clear selection

Please answer the following questions, if not relevant choose NA column. (You need not answer yes to all or any questions for you to undertake a role) *

Yes

Not Applicable

I know how to use EMIS (clinical computer system).

I am able to safely deliver an IM injection.

I have had training on disposal/management of sharps, including how to manage a needle stick injury.

I have had training and am competent in the use of PPE (Personal Protective Equipment).

I have an up to date DBS in place. (Criminal Record Check)

I am current registered as a medical student or qualified healthcare professional in the UK.

I have the right to work in the UK.

I have completed a personal covid risk assessment and I am at low personal risk.

I have completed training (e-LFH) on delivery of the Covid Vaccine.

I have a vehicle and I am willing to drive.

Yes

Not Applicable

I know how to use EMIS (clinical computer system).

I am able to safely deliver an IM injection.

I have had training on disposal/management of sharps, including how to manage a needle stick injury.

I have had training and am competent in the use of PPE (Personal Protective Equipment).

I have an up to date DBS in place. (Criminal Record Check)

I am current registered as a medical student or qualified healthcare professional in the UK.

I have the right to work in the UK.

I have completed a personal covid risk assessment and I am at low personal risk.

I have completed training (e-LFH) on delivery of the Covid Vaccine.

I have a vehicle and I am willing to drive.

Which role(s) would you currently be able to undertake? (you can select more than one) *

Reception (Checking in patients)

Patient flow co-ordinator (directing and supporting patients through the system)

Patient observation (monitoring patients post vaccination and booking second appointments)

Data Entry (inputing details of vaccinated patients into the online portal)

Vaccinator - as a fully qualified healthcare professional (Doctor, Nurse, Paramedic etc)

Vaccinator - as a healthcare student or 'lay vaccinator'

Volunteer driver - supporting vaccinators delivering housebound patient vaccines

Required

I would be happy to help at

Either

Morris House Group Practice - Lordship Lane Site

Bounds Green Group Practice

Clear selection

Please choose one: *

I am happy to volunteer my time.

I would like to be paid for my time. (for qualified clinical staff or admin staff able to offer regular sessions))

Submit

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