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    NHS clinical agency assignment checklist template

    A temporary worker assignment checklist is the form a supplier completes for every booking with an NHS trust under the RM6281 Clinical and Healthcare Staffing framework. This Word template follows its structure in the agency's own brand: the Buyer's IR35 status determination statement; contractual details (framework and lot, call-off contract, buyer and supplier references); the requirement (role, band or grade, working pattern, dates, reason for the booking); the worker, with professional registration, qualifications and mandatory training; the hourly charge rate and supplier fee for days, nights and Saturdays, and Sundays and bank holidays; the PAYE route; conflicts and other placements; the validated documents and checks; the enhanced DBS check; occupational health; the Buyer's additional requirements; the supplier declaration; and a Still needed list. Formatix fills it from the worker's CV, the booking and your compliance notes. Ticks, rates and dates appear only where those documents state them. It is a Formatix template, not an official form.

    Every booking under the clinical framework needs this checklist, and its facts sit in the worker's CV, the trust's order, the payroll arrangement and the compliance file. This template brings them onto one form. The IR35 determination is the Buyer's and is copied only when the order states it, rates are copied exactly, and each check is ticked only when your records confirm it was done.

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    See it in your firm's brand

    Create your free account and we read your website for your logo, colours and fonts, then open the NHS clinical agency assignment checklist in your brand, ready to change or save. Every other template follows in your brand too.

    Work email required; personal inboxes are not eligible. 10 free credits, no card. We read your public website once to find your brand.

    NHS clinical agency assignment checklist template, page 1: example in Formatix branding with fictional content
    NHS clinical agency assignment checklist, first page. Shown in Formatix branding with fictional example content; yours is built in your brand.

    What's in the template

    The 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.

    • The Buyer's IR35 status determination, only as stated
    • Contractual details and the requirement
    • Worker, professional registration, qualifications and mandatory training
    • Charge rate and supplier fee, PAYE route, conflicts and other placements
    • Validated documents, enhanced DBS and occupational health
    • Supplier declaration (signature left blank) and Still needed

    What it's for: Every clinical booking with a trust under RM6281.

    WordDelivered as an editable Word file, or saved as PDF.

    Who uses it

    • Nursing and healthcare staffing agencies

      One checklist per booking for nurses, healthcare assistants and allied health workers, in your brand.

    • Medical locum agencies

      The same checklist for doctors booked through the clinical framework.

    • Compliance teams

      What the records confirm, set out the way the checklist asks for it, with the gaps listed.

    Every page of the example

    The example is in Formatix branding with fictional content. When you pick this template, it is rebuilt with your logo, colours and fonts before you use it.

    NHS clinical agency assignment checklist template, page 1: example in Formatix branding with fictional contentNHS clinical agency assignment checklist template, page 2: example in Formatix branding with fictional content

    How you use it

    1. 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. 2

      Drop the CV and your records

      Upload the worker's CV with the trust's booking or order and your compliance notes: training certificates, DBS and occupational health records, the agreed rates and the pay route. One credit fills one document.

    3. 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 or the trust, 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 the official RM6281 form?
    No. It is a Formatix template for suppliers submitting to NHS trusts under the RM6281 framework, and its footer says it is not an official form. The structure follows the RM6281 assignment checklist, published under the Open Government Licence v3.0. It carries no NHS, framework or government logo. Check the version the trust asks for before you submit.
    Does Formatix decide the IR35 status?
    No. The status determination is the Buyer's. Inside or outside IR35 is ticked only when the trust's order or your notes state the Buyer's determination, with the reasons and disputes address as the Buyer gave them. It is never worked out from the pay route. When it is not stated, the boxes stay unticked, the matching statement waits for it, and it goes on the Still needed list.
    Will it tick a check because it is usual for the role?
    No. A check is ticked Yes only when your notes confirm it was completed and the validated document is held. A check that is not mentioned is left unticked and added to the Still needed list; it is never marked No by default.
    Does it calculate the supplier fee or night rates?
    No. Charge rates and supplier fees are copied exactly as written. A fee is never worked out from a charge rate, and a night or weekend rate is never worked out from a day rate.
    Who signs the supplier declaration?
    Your authorised signatory. The name, position and date fill only when your notes give them, and the signature is always left blank.

    Related templates and pages

    Use the nhs clinical agency assignment 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.

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