Forms and templates for the employment and management of Locum Medical Officers

The documents at Appendix A to NSW Health PD2019_006 Employment and Management of Locum Medical Officers by NSW Public Health Organisations, together with the Standard Agreement for the Employment of Locum Medical Officers in NSW Public Health Organisations at Appendix B, are set out individually in PDF and Microsoft Word formats below for use by Medical Locum Agencies and NSW Public Health Organisations.

Note that these documents complement the Locum Medical Officer policy requirements and the Medical Locum Agency Requirements and are standard documents for use statewide by all NSW Public Health Organisations and Medical Locum Agencies. These documents must not be altered in any way.

• Document 1: Locum Medical Officer Pre-Placement Checklist
  To be completed by a Medical Locum Agency and provided to a NSW Public Health Organisation Medical Workforce Unit. This document captures the essential requirements for the employment of Locum Medical Officers in NSW Public Health Organisations, including a candidate’s current registration status, results of criminal history checks, health and vaccination status, references, completion of mandatory online pre-employment training and knowledge of NSW Health policies, approval for secondary employment and fitness to perform a role.
• Document 2.1 – Clinical Skills Self-Assessment
  To be completed by a Locum Medical Officer and provided to a Medical Locum Agency for submission to a NSW Public Health Organisation Medical Workforce Unit.
• Document 2.2 – Referee Check for Clinical Skills
  To be completed by a Medical Locum Agency and provided to a NSW Public Health Organisation Medical Workforce Unit.
• Document 2.3 – Referee Check for Professional Behaviour
  To be completed by a Medical Locum Agency and provided to a NSW Public Health Organisation Medical Workforce Unit.
• Document 2.4 – Referee Check for Professional Behaviour
  To be completed by a Medical Locum Agency and provided to a NSW Public Health Organisation Medical Workforce Unit.
• Document 2.5 – Referee Check for Professional Behaviour
  To be completed by a Medical Locum Agency in consultation with a recent supervisor (within the past 12 months) and provided to a NSW Public Health Organisation Medical Workforce Unit.
• Document 3: Approval for Secondary Employment
  A template for completion by a Medical Officer who has substantive employment with a NSW Public Health Organisation to demonstrate that they have approval to undertake secondary employment as a Locum Medical Officer. This document must be provided on registration with a Medical Locum Agency.
• Document 4: Role Specification template
  To be prepared and provided by a Clinical Department to a NSW Public Health Organisation Medical Workforce Unit and incorporated with an Order to a Medical Locum Agency to describe the duties and requirements of a role to be filled.<
  Role Specification - Microsoft Word version
• Document 5: Criminal Record Statutory Declaration – Australia
  To be completed by a Locum Medical Officer, and provided by a Medical Locum Agency​ to a NSW Public Health Organisation Medical Workforce Unit. This document must be completed by a Locum Medical Officer, whose National Police Certificate is current, to declare any convictions or pending charges since the date of the Certificate.
• Document 6: Minimum requirements for the Locum Medical Officer Pre-Placement and Orientation Packs
  This document sets out the minimum requirements for the information to be provided in Locum Medical Officer Pre-Placement and Orientation Packs. The Pre-Placement Pack is to be prepared by a Medical Workforce Unit and provided to a Locum, via a Medical Locum Agency, in advance of a placement. It is intended to assist in orientation to the department, facility and health network in which the Locum Medical Officer will be placed, as well as the town or locality, to include any relevant information about local amenities. The Orientation Pack is to be prepared by a Clinical Department and provided to a Locum Medical Officer on their presentation for duty to provide succinct information about the department, the facility, local clinical protocols, communication systems and emergency/resuscitation arrangements, reporting and supervisory responsibilities and supports to the role.
• Document 7: Locum Medical Officer Performance Assessment
  A tick-box form for completion by a Locum Medical Officer’s supervisor or Clinical Department Head to provide feedback to a Medical Workforce Unit and Medical Locum Agency on the Locum Medical Officer’s performance.
• Document 8: Locum Medical Officer feedback form template
  This template may be adapted for use by Public Health Organisations as a form to be provided to Locum Medical Officers with the Orientation Pack at the start of a placement in a NSW Public Health Organisation. Locum Medical Officers are encouraged to complete and provide this form to the Medical Workforce/Locum Manager and/or to their Medical Locum Agency on completion of a placement.
• Standard Agreement for the Employment of Locum Medical Officers in NSW Public Health Organisations