Flex Staffing Program - Work Order Survey

GRMC's Flex Staffing program is designed to keep everyone working--especially in those times of low census. Please tell us your departmental needs so we can match employees to the jobs, duties, and projects available.

1. Sponsoring Department (Please note that hours worked will be charged to this department)

Sponsoring Department (Please note that hours worked will be charged to this department)

2. Contact Name

Contact Name

3. Contact Phone

Contact Phone

4. E-time Account Number to charge work to:

E-time Account Number to charge work to:

5. E-time Job Code to charge work to:

E-time Job Code to charge work to: 11 med asst

22 coor

30 RN

31 Profession

32 transcript

35 Avsr nur

40 LPN

41 tech

50 Aide

51 housekeeper

52 food service

54 mt'nce mech

60 clerical

61 coder

20 mgmt

30 RN

31 profession

32 transcript

33 PRN

34 chaplain

35 advsr nur

40 LPN

41 tech

50 aide

51 housekeeper

52 food service

54 mtnce mech

60 clerical

61 coder

6. What priority do you consider this work needs done?

What priority do you consider this work needs done? High

Medium

Low (people may be diverted to fill higher priorities if necessary)

7. Describe Work Your Department Needs Done

Describe Work Your Department Needs Done

8. Must work be done on a specific date?

Must work be done on a specific date? Yes

No

9. If yes to preceding question, specific date required:

If yes to preceding question, specific date required:

10. Does work need to be done in a specific shift?

Does work need to be done in a specific shift? Yes

No

11. If yes to preceding question, shift requirement:

If yes to preceding question, shift requirement:

12. Describe Special Skills Required for This Job

Describe Special Skills Required for This Job

13. Please list physical requirements of the job:

Please list physical requirements of the job: prolonged standing

frequent walking

pushing/pulling

squatting or kneeling

frequent or prolonged bending at waist

upper body strength

lifting no more than 20# and none of the above (class 0)

prolonged sitting

lifting up to 35# on an occasional basis (Class 1)

lifting up to 55# on an occasional basis (Class 2)

lifting more than 55# on an occasional basis (Class 3)

pinching/grasping

Other (please specify)

14. Does this task/job require exposure to blood or other potentially infectious materials?

Does this task/job require exposure to blood or other potentially infectious materials? Yes (Category A Occupational Exposure)

No (Category B Occupational Exposure)

15. Describe Special Requirements of the Job (safety needs, special tools or clothes, etc.)

Describe Special Requirements of the Job (safety needs, special tools or clothes, etc.)

16. Deadline by Which the Task Must be Completed

Deadline by Which the Task Must be Completed

17. Estimated Length of Time to Complete Job

Estimated Length of Time to Complete Job

18. Location of Where Task Will Be Completed

Location of Where Task Will Be Completed

19. Today's Date

Today's Date

Flex Staffing Program - Work Order

1. Introduction