COVID-19 vaccination staff support

The COVID-19 vaccine staff request form is for primary care networks and Dorset County Hospital and University Hospitals Dorset staff who need support to deliver the COVID-19 vaccine.

Requests should be sent as far in advance as possible and as a minimum three days before the shift. Requests can be for one shift or for multiple shifts up to 12 weeks in duration.

If you agree a shift(s) with an individual worker, please record the shift details on the form as per normal and the name of the employee who you have agreed the work with. We will book the shift and allocate it to the individual to ensure they are paid correctly. Trust bank will not cancel an individual from an agreed shift to work on alternative shift so it is important when are making arrangements directly with individuals that they are not already committed work elsewhere. Trust bank is operational Monday-Friday 8am-7pm and Saturday and Sunday 9am-3pm.

If you wish to cancel a shift please notify a minimum of three days in advance of the cancellation.

You can complete the form or the spreadsheet below. There is a team of staff working and the inbox is regularly monitored during opening hours, every effort will be made to fill requests and you will be kept informed. Please do not email trust bank staff directly as we can not guarantee individual inboxes are monitored .

Request for multiple shifts

Request for single shifts

Name of person completing the form *

Email address *

Date of request: *

Full address of location of site required to attend *

Date required *

Role required (band 3,4,5,6) e.g. admin, HCA, screener, drawer upper, vaccinator and how many needed? *

Shift start time *

Shift end time *

Recipients *

Which COVID-19 vaccine is it? *

Type of shift *

Name of person to report to, where to park and any other useful information *

Professionals