Word template · Reports
Agency worker placement checklist template
An agency worker placement checklist is the checklist an agency completes for each placement it puts to an NHS trust. This Word template has three variants, chosen by staff group: medical locum (GMC or GDC registration, life support and last appraisal), allied health and healthcare science (HCPC or other regulator, life support and mandatory training) and nursing (NMC, life support, mandatory training and revalidation). Each covers the placement (trust, reference, reason, grade or band, job title, specialty, dates, working pattern, hours and on-call); pay and charges only as stated; documents and checks (full CV, photograph, ID, right to work, previous work at the trust, availability for the whole period, English); professional registration and last check; DBS and occupational health; training; two references; a Still needed list; and a supplier declaration with a blank sign-off. Formatix fills it from the worker's CV, the booking and your compliance records. Ticks appear only where those documents state them. It is a Formatix template, not an official form.
Trusts ask agencies to confirm the same checks for every placement, with different registration and training rows for doctors, allied health staff and nurses. This template switches those rows by staff group and fills the rest from the CV, the booking and your compliance file. A box is ticked only when the documents give the answer; otherwise it stays unticked and the item goes on the Still needed list.
10 free credits, no card needed. One credit fills one document.
What's in the template
The checklist an agency completes for each placement it puts to an NHS trust, in three variants by staff group (medical locum, AHP / healthcare science, nursing) that switch the registration and training rows: booking, grade or band, dates, hours and on-call, pay and agency fee only as stated, CV, photo, ID and right to work, registration and last check, DBS, occupational health, life support and appraisal or mandatory training, English, two references, a still-needed list and a blank supplier sign-off. Ticks only as stated. Not an official form.
- Staff group: medical locum, AHP / HSS or nursing
- Placement: trust, reference, grade or band, dates, pattern, hours, on-call
- Pay and charges, only as stated
- Documents and checks, registration, DBS and occupational health
- Training, English and two references
- Still needed and supplier declaration (sign-off left blank)
What it's for: Confirming the checks for each placement with a trust.
WordDelivered as an editable Word file, or saved as PDF.
Who uses it
Medical locum agencies
The medical locum variant with GMC or GDC registration, life support and last appraisal.
Nursing and allied health agencies
The nursing and AHP variants with registration, mandatory training and revalidation.
Compliance teams
One checklist per placement showing what the records confirm and what is missing.
How you use it
- 1
Pick the template
Open Formatix, choose this template in Studio, and give us your website. We pull your logo, colours and fonts and rebuild the template in your brand. You see a sample before you use it.
- 2
Drop the CV and your records
Upload the worker's CV with the trust's booking and your compliance records: ID, right to work, registration check, DBS, occupational health, training certificates, references and the agreed rates. One credit fills one document.
- 3
Check, chase and send
The filled document appears beside the original for checking. Get the items on the Still needed list from the worker, remove that box, then download the Word file.
Download or automate? The free download is a plain file you fill in by hand. In Formatix the template is rebuilt in your brand, with your logo, colours and fonts taken from your website, and filled from a CV or your notes in about a minute. What you keep is the finished document: an editable Word, PowerPoint or Excel file.
Ask for changes in plain words, such as "move the photo to the right" or "add a Languages section", and the template is updated with the rest of its formatting kept. If you already have a document you send clients, upload that instead and Formatix turns it into a template. How Studio builds templates
Questions about this template
- Is this an official NHS form?
- No. It is a generic Formatix template for suppliers submitting agency workers to NHS trusts, and its footer says it is not an official form. It carries no NHS or trust logo. If a trust gives you its own checklist, upload that and Formatix builds the template from it.
- How is the staff group chosen?
- From the CV or the booking, only when they make the profession clear. The staff group decides which registration and training rows the checklist shows. When it is not clear, every row is shown.
- Will it answer No when a check is not mentioned?
- No. Every Yes or No is filled only when the documents say so. A check that is not mentioned stays unticked and goes on the Still needed list.
- Does it calculate the total hourly charge?
- No. Hourly pay, agency fee, total hourly charge and other costs are copied exactly as stated, with the currency sign. None is worked out from another, and VAT is never added.
- Who signs it?
- The supplier. The sign-off block is left blank for completion by hand.
Related templates and pages
WordNHS clinical agency assignment checklistThe temporary worker assignment checklist a supplier completes for every booking with an NHS trust under the RM6281 Clinical and Healthcare Staffing framework: the Buyer's IR35 status determination, contractual and booking details, the worker, registration and qualifications, mandatory training, charge rate and supplier fee, PAYE route, conflicts, validated documents, enhanced DBS, occupational health, the supplier declaration and what is still needed. Ticks only as the documents confirm. Structure based on the RM6281 assignment checklist (Open Government Licence v3.0). Not an official form.
WordLocum CV compliance reviewA one-to-two-page review of a locum doctor's CV against what trusts require before a doctor is deemed suitable: full name, availability, clinical and specialty experience, gaps explained, GMC registration type, number, currency and restrictions, DBS, two recent references and hepatitis B evidence, each marked Present / Missing / Unclear from the CV with the evidence quoted or what is missing. Ready to submit is ticked only when every requirement is Present; a still-needed list follows. Not an official form.
Use the agency worker placement checklist in your brand
Give us your website, and the template is rebuilt with your logo, colours and fonts. Your first ten documents are free, with no card, valid for 14 days.
Formatix fills it from the CV for you: see our CV formatting software, or bulk CV formatting for a whole shortlist at once.