Burscough COVID Vaccine Centre staff sign up sheet.

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Thanks for getting involved and supporting the most comprehensive and important vaccine programme known. We really appreciate your help.
We Need:
-Nurses £25 - £32 per hour gross depending on sociable / unsociable hours (bank holiday and Sunday).
-Supervised Vaccinators (who have completed the training) £15 - £18 per hour gross depending on sociable / unsociable hours (bank holiday and Sunday).
-Blood takers (who have completed the training) £12 - £14 per hour gross depending on sociable / unsociable hours
-Administrative Staff
-Cleaners £10 an hour gross
-Pharmacists /Pharmacy Techs £25 - £32 per hour gross depending on sociable / unsociable hours
-General Volunteers (parking/door security)

The service will be running 8am till 8pm 7 days a week in shifts on a contractors agreement basis. Payment will be gross at month end.
Unsociable hours payments will be made for Post 8pm, Bank Holidays and Sundays.
Please complete the required fields.
Please note the consent statement at the base.

Thanks again for your support.
The Burscough COVID team

Forename(s) *

Surname *

Email Address *

Phone number *

Which role are you able to perform *

Nurse Vaccinator / Supervisor (Must registered Nurse)

Supervised Vaccinator

Pharmacist

Admin

Cleaner

Taking blood Phlebotomy (practice based)

General voluntary work

Marshalling and directing indoor and outdoors

Driver (Over 25 with clean licence).

Other:

Required

What level of training do you have

Registered Nurse

Registered Pharmacist

Completed Vaccination course (General Vac / COVID)

Health Care Assistant NVQ

Phlebotomy / blood takers course

Other

Not applicable

Clear selection

If you have a current Job what is your role

Nurse

Pharmacist

HCA

Phlebotomist

NHS receptionist

NHS Admin

Other Admin

Other:

Some general information to help us arrange placement please check the box if you fit the criteria / answer is yes

Do you have a valid DBS certificate

Are you vaccinated and immune to Hepatitis B

Do you currently work in the NHS

Do you have an NHS Smart Card

Are you able to the the EMIS GP system

Have you had anaphylaxis training

Have you had Basic Life Support training

Which days and times can you work tick the box

08:00 to 13:00

13:00 to 17:00

17:00 to 20:00

Monday

Tuesday

Wedensday

Thursday

Friday

Saturday

Sunday

Influenza Vaccine *

I have had my Flu vaccine this year

I am willing to have a flu vaccine if offered by the practice

Required

Any other information about yourself you feel would be relevant.

I consent to this data being stored by Burscough Family Practice for the purposes of staffing the COVID vaccination centre only. *

Yes

I consent to Burscough Family practice sharing the information above with other practices in West Lancashire for the purposes of staffing Other COVID vaccination Centres

Yes

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