Part A: Personal details(All fields are mandatory and must be fully completed)

Title
First Name
Last Name
Home Address
Home Telephone / Mobile Telephone / This number is used to send out notice of overdue items
Email Address / (Please note that if using a Hotmail account the libraries may not be able to contact you)

Part B: Work / Placement details

Employer or University (i.e. Hospital or University or Surgery)*
Job Title (i.e. F1, ST, Student, Secretary)*
Department/Ward
Telephone Number
Bleep
Contract/Placement End Date(if applicable) / □or Permanent Contract
Manager Contact Details
Students Only: (Only to be completed if Student on Placement) / Student ID/Card Number:
Course Completion Date:

DECLARATION

Please read and sign:
By using thefacilities provided by KnowledgeServices, I agree to abide by the Conditions of Membership (available from staff and the intranet ) I understand that I am financially responsible for making good the loss of, or damage to, any items on loan to me, I also undertake to keep Knowledge Services informed of my current work/home address. I understand that these details are held on the membership card and management system, and that this information will only be available to me and NHS knowledgestaff which may involve other NHS libraries, or, for students their University body. I consent to this information being held and used in accordance with current Data Protection legislation and local policies. I accept that failure to comply with the Internet Code of Conduct may result in disciplinary proceedings and understand that all computers are subject to remote surveillance.
Signature Date
…………………………………………….. ………………………………..

Database and Journal Access for NHS Staff (including Hospice staff)

The licensing requires that all users have a username and password to access these resources.

Access to databases and e-journals (NHS Athens username and password): including Medline, CINAHL, PsycINFO, AMED, BNI, EMBASE, Emerald other resources are available via NHS Evidence. / You will need to self register for a NHS Athens Username and password. Please ask Knowledge Services Staff for details.

TERMS AND CONDITIONS

  1. Anyone wishing to use Knowledge Services facilities must show valid ID (Trust ID card) and complete a membership form.
  1. A membership card will be issued to all registered members. The information contained on this card is unique to each member and is required by Knowledge Services staff. Anyone not in possession of a valid membership card will not be permitted to request or borrow items or to use any facilities. If a card is lost, the member must inform staff and a new card must be issued before access to facilities is reinstated. There is a charge of £1.00 for replacement card to cover the cost of the card and administration.
  1. Up to 10 items may be borrowed at a time usually for 3 weeks. It is the responsibility of the borrower to check the due date and to return items promptly. Items may be renewed in person, by telephone, via email or by using your PIN via the Internet and a maximum of 6 renewals will be permitted before an item must be returned. Reference books and journals can not be borrowed.
  1. Items on loan to another reader can be reserved and will be recalled if they are requested by another member. Readers are asked to return items promptly or face the possibility of a charge.
  1. All items for loan must be issued either by a member of staff or via the Self Issue Machines.
  1. Members must comply with copyright legislation.
  1. Members are encouraged to use the internet, but reminded that it should be used for work purposes only. We would ask that you do not disclose any passwords.
  1. Members are expected to show respect and consideration to Knowledge Services staff and other members. Phone calls should be kept brief and mobiles where possible set to silent or vibrate.
  1. Swipe cards are for PERSONAL STUDY ACCESS ONLY and are NON-TRANSFERABLE members must not open the facilities to any other person.
  1. Swipe cards must be shown when requested and will be de-activated YEARLY during the last week in July. If you are continuing with the Trust you must contact Knowledge Services and confirm your details are correct.
  1. Laptops and other devices brought into the facilities are the responsibility of the member and mustNOT be connected to any Trust property i.e. electrical socket, network point or telephone line.

Conduct

Violation or abuse of any Knowledge Services Policy or Conditions of use will lead to the suspension of facilities and will be reported to the Director of Medical Education for further action.

Y://Share/ERMEC Admin/Stationery/Forms/Membership

Revised 22 May 2009/ Amended 18 June 2009js/Amended 7 Dec 2009js

Revised 24 March 2011s August 2011 js