Induction / Annual Checklist Form Annex A

Newcross Healthcare Solutions Ltd.

Applicant Name:

Date Completed:

Date

Branch

In accordance with the SSSC (Scottish Social Services Council) Codes of Practice (Revised November 2016) Newcross Healthcare Solutions are happy to support and endorse the following employee’s application to the register based on the compliance with the guidelines as laid down in the Fitness to Practice section. Please note: Nurses are exempt from completing this form.

I have read and will abide by the SSSC Codes of Practise as revised in November 2016

I will pay my membership fee and any annual renewal fee in accordance with SSSC requirements

I will notify SSSC of any changes to my personal circumstances

I will notify SSSC of my current employer/employers’ status

I will notify SSSC when I am no longer an employee of Newcross Healthcare Solutions

I will make sure that I engage with Newcross Healthcare Solutions to ensure that my Post Registration Training & Learning (PRTL) meets the SSSC requirements

I will ask for support and help where I have recognised things could have been handled better

I will report any concerns about my own practises or those of others in a candour manner

I will willingly participate in any investigations providing evidence/statements or attend meetings as required

I will support other professional colleagues in maintaining and upholding their codes of practise

I will notify my employer and SSSC of any health concerns temporarily or otherwise that may affect my ability to uphold my SSSC code of practise

I will be honest and open about any disciplinary/training needs which may affect my fitness to practise with my employer

I will be honest and open with my employer in respect of my criminal record/convictions incurred throughout my employment in respect of the SSSC code of practise

We will in agreeing to endorse this employee’s application to register with the SSSC ensure that our company policies and procedures support the individual to achieve their maximum potential

We will agree to make any referrals to the SSSC under fitness to practise in accordance with the guidelines as laid down in the November 2016 revised codes of practise

Any failure to comply with the SSSC codes of practise may result in your file becoming inactive whilst an investigation is carried out in consultation with our HR department, Fitness to Practise Registrars at SSSC, Disclosure Scotland and our Senior Management Team. Dependant on the outcome of the investigation a referral to SSSC may be required. During any period of inactivity, you will not be offered any work duties until the matter has been resolved and concluded in a safe and satisfactory manner in keeping with all legislative requirements. On occasion, there may be some extenuating circumstances that arrive and they will be considered on an individual basis with accordance with "Fitness to Practise" within the SSSC code.

Parts of the Register - Select All

Other

Date registered

Date

Date for annual renewal

Date

Are you registered with conditions? - i.e. SVQ2

I understand that the above details are only applicable to Newcross if I add Newcross Healthcare Scotland as an employer to my registration with the SSSC.

I sign to declare I have read, completed and understood our full commitment to each other in respecting and upholding the SSSC Codes of Practise and both parties have accepted and agreed to fulfil their accountable responsibility to the SSSC code in respect of your employment with Newcross Healthcare Solutions

Employee Initials:

Employee Printed Name:

Employee Grade:

Employee Signature:

Office Staff to Attach to Monty Under ASD 135 Annex A

Induction / Annual Checklist Form Annex A - SSSC Endorsement

Employee Responsibilities:

Employer Responsibilities:

SSSC Register

Sign Off: