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SCHEDULE 1 ASSIGNMENT DETAILS FORM

Step 1 Step description

Step 2 Step description

SCHEDULE 1 ASSIGNMENT DETAILS FORM

To be obtained from Hirer

DETAILS OF HIRER

Name of the Hirer *

Nature of the Hirer’s business *

Assignment Details

Start date of assignment *

Likely duration of the assignment *

Job Title *

The type of work

Location of work *

Hours of work *

The experience, training, qualifications and any authorization necessary or required by law or a professional body

Manual Handling, Fire Training, First Aid, Health & Safety Training, Safeguarding of Vulnerable Adults, Basic Food Hygiene and Safety, Infection Control, Epilepsy training

Any known health and safety risks and the steps the hirer has taken to reduce the risks

Worker must be aware of and abide by Health and Safety standards. PPE will be provided by the hirer for relevant assignment.

Pay Title

Any expenses payable

Actual Rate of Pay or Actual Qualifying Period Rate of Pay and any Emoluments

Intervals of payment: (N.B Under the Conduct Regulations the intervals of payment should be set out in the Agency Worker’s contract)

Period of Extended Hire and Transfer Fee

Notice period required where the Hirer wishes to engage the Agency Worker for a Period of Extended Hire. *

Period of Extended Hire if the Hirer wishes to engage the Agency Worker and avoid paying a Transfer Fee *