General Request for Staff Form (QLD)
Updated 02.12.2025
Request date/time - no need to fill out this section it's automatic
-
Day
-
Month
Year
Date
1
2
3
4
5
6
7
8
9
10
11
12
:
Hour
00
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
Minutes
AM
PM
AM/PM Option
Referring Agency
*
Office/Branch Name and Address
Contact Person Name
*
Contact Person Email Address
*
Contact Person Number
*
Child Safety Service Centre Manager Name
Child Safety Service Centre Contact Number
Contact Name for Accounts and Invoicing
*
Contact Number for Accounts and Invoicing
*
Is a purchase order required for payment of invoice? If so please add to the box provided
*
Yes
No
Other
Do you require a quote for this support request?
*
Yes
No
Requirements of Worker
Category 1 (Entry level Experience)
Category 2 (Experienced)
Category 3 (Highly Experienced)
Category 4 (Professional Experience)
Is COVID 19 Vaccination required for the staff providing support?
*
Yes
No
Is your organisation a Licensed Care Service and does the worker require an LCS clearance with your organisation? NOTE: An LCS clearance is only available if the requesting organisation is a Licensed Care Service. Further information can be obtained here: https://www.cyjma.qld.gov.au/resources/dcsyw/about-us/partners/licensing/faq-organisation-apply-care-service.pdf
*
Yes
No
Date and Time of Shift
*
Job Brief
*
Does the assigned ProCare Australia worker require an NDIS Check Clearance to complete the shift requested?
*
Yes
No
Please upload any safety plans, PBS plans, risk assessments or any additional information which will assist in suitable matching of our staff to your request.
Browse Files
Upload relevant plans/information
Cancel
of
Approved Attendee/s (if required)
*
Rows
Name One
Name Two
Name Three
Name Four
Attendee/s Name
Relationship to Young Person
Are Case Notes required to be completed?
*
Rows
Not Required
15 Minutes
30 Minutes
Case Notes
Children/Young Person Information
*
Child Safety Seat
*
Forward Facing Infant
Rear Facing Infant
Booster Seat
No Booster seat
Are there know behaviours displayed by the Young Person when sitting in Child Safety Seats?
*
Yes
No
Please provide details of known behaviours:
*
eg: removing arms from restraint straps, removing seatbelt, opening doors, seat kicking, spitting on staff
Known Safety Concerns or Diagnosis related to any of the attending Children?
*
Please include all known challenging behaviours and an overview of any significant events that has the potential to influence the behaviours of the Young Person.
Known Safety Concerns or Diagnosis related to any of the attending carers, parents, family members?
*
Please include all known challenging behaviours and an overview of any significant events that has the potential to influence the behaviours of the attending adults.
I acknowledge the information provided above is factual, and comprehensive at the time of submission of this form. I further acknowledge if additional information about safety concerns/diagnosis changes, I will update ProCare Australia with time of the essence?
*
Yes
No
Primary Carer Name
*
Primary Carer Address
*
Primary Carer Contact Number
*
Pre-Approved Allowances (if required)
*
Authorisation of shift Approval (If you require time sheets to be signed off after the shift please provide details below)
*
Rows
Name
Email
Position
Contact Number
Approver
Submit
Should be Empty: