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Home - Work with us - New starters form

New starters form

This form is for new starters with the Trust. Please complete this before your start date.

Are you a new starter with the Trust?*
- Yes
- No
Are you an existing member of staff?*
- Yes
- No
Please complete the COVID-19 risk assessment on StaffZone.
Please do not complete this form.
Name*
First Name Surname
Date of birth*
Division*
Service/Department*
Do any of the following risk factors apply to you? Please check all that apply:*
- Are you male?
- Are you over 60?
- Are you from a Black, Asian or Minority Ethnic background (BAME)?
- Are you pregnant?
- Do you have an underlying health condition?
- None of the above categories apply to me.
Do you have any other concerns which you would like reviewed as part of a risk assessment?*
- Yes
- No
What concerns would you like to be reviewed?*
You should discuss these further with your new manager.
Do you understand the importance of the following measures which apply to all staff to limit the transmission of infection and protect you, your colleagues and service users?*
- Regular and thorough handwashing
- The need to wear PPE suitable to your role
- Following social distancing and other preventative measures e.g. wiping desks, not sharing equipment, reducing face to face meetings
- Yes
- No - Please ask your manager for further advice.
Privacy Policy*
Please read our Privacy Policy to find out how we use your information.
I have read, understood and agree to the terms outlined in the Privacy Policy.
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Page last reviewed: 13/10/2022

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Trust Headquarters

St Catherine's Health Centre, Derby Road, Birkenhead, Wirral CH42 0LQ

Telephone

0151 514 2888

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