NHS FIFE Forms must be submitted within 2 days of final shift worked

PRINT NAME CLEARLY BELOW
……………………………………………….
Bank Payroll Number…………………………
Band……………………….
Substantive Position Held & Band
…………………………......

STAFF BANK CLAIM FORM

For the week of ……………………….

Declaration by Claimant

I declare that the information I have given on this form is correct and complete and I have not claimed

elsewhere for the hours/shift detailed on this timesheet. I understand that if I knowingly provide false

information this may result in disciplinary action and I may be liable for prosecution and civil recovery

proceedings. I consent to the disclosure of information from this form to and by the Health Board, the

Common Services Agency and any other body or persons by whom I am employed for the purpose of

verification of this claim.

Signed……………………………………………….. Date………………………………………..

To be filled in by the bank nurse. The Charge Nurse (or nurse in charge) must sign this form. Return to Nurse Bank Office, Rowan House, Kirkcaldy by 2.00 pm every Tuesday at the latest. Failure to do so will delay payment.

DAY / DATE / REF NO / START TIME / FINISH TIME / BREAKS / Total
hours to be
paid / Clinical Area
& Location / Nurse in Charge/
Authorised signature / Authorised Name & Band
(block capitals)
Mon / : / :
Tues / : / :
Wed / : / :
Thurs / : / :
Fri / : / :
Sat / : / :
Sun / : / :

FOR OFFICE USE ONLY

Total ND Sat Sun PH

.

NURSE BANK STAFF INFORMATION

Please read the following notes carefully before completing your claim form.

·  BANK STAFF ARE PAID WEEKLY (there is one week between the week the shift was worked and the week payment is made).

·  ALL INFORMATION REQUESTED + BOOKING REF. NO. MUST BE PROVIDED TO AVOID DELAYED PAYMENT.

·  INCOMPLETE FORMS WILL BE RETURNED TO BANK STAFF FOR COMPLETION.

·  ANY LATE CLAIM FORM SUBMISSIONS WILL RESULT IN DELAYED PAYMENT.

·  EACH SHIFT MUST BE VERIFIED WITH A SIGNATURE FROM THE NURSE IN CHARGE OF THE AREA.

·  IT IS IMPORTANT YOU IDENTIFY WHICH AREA AND LOCATION YOU WORKED AT.

·  PLEASE INFORM THE NURSE BANK OF YOUR AVAILABILITY. THIS SHOULD BE ACCURATE AT ALL TIMES. YOU MUST NOTIFY THE NURSE BANK IF YOU HAVE GIVEN AVAILABILITY BUT ARE UNABLE TO WORK.

·  FAILURE TO KEEP YOUR AVAILABILITY ACCURATE MAY RESULT IN LOSS OF WORK OPPORTUNITIES.

·  ALL BANK STAFF MUST ADHERE TO THE UNIFORM POLICY. IF YOU HAVE A QUERY RE UNIFORMS CONTACT THE NURSE BANK OFFICE.

·  PLEASE ENSURE THAT YOU DISPLAY YOUR IDENTIFICATION BADGE AT ALL TIMES.

·  THE NURSE BANK OFFICE MUST BE NOTIFIED OF ANY CHANGES E.G.ADDRESS, BANK DETAILS, AS SOON AS POSSIBLE.

·  NHS FIFE RUNS A NO SMOKING POLICY THROUGHOUT ALL SITES.

CLAIM SHEETS SHOULD BE POSTED TO THE NURSE BANK OFFICE, ROWAN HOUSE, GROUND FLOOR, WILLOW DRIVE, KIRKCALDY, KY1 2LF OR ALTERNATIVELEY PUT THROUGH THE LETTER BOX OF THE ABOVE ADDRESS.