Common use of WORKING CONDITIONS Clause in Contracts

WORKING CONDITIONS. In order to effectively resolve workload issues, please provide details about the working conditions at the time of occurrence by providing the following information: Regular Staffing #: RN RPN Unit Clerk Service Support Actual Staffing #: RN RPN Unit Clerk Service Support Agency/Registry RN: Yes No How many? Novice RN Staff on duty* Yes No How many? RN Staff Overtime: Yes No If yes, how many staff? *as defined by your unit/area/program. If there was a shortage of staff at the time of the occurrence, (including support staff) please check one or all of the following that apply: Absence/Emergency Leave Sick Call(s) Vacancies Off unit Management Support available on site? Yes No

WORKING CONDITIONS. In order to effectively resolve workload issues, please provide details about the working conditions at the time of occurrence by providing the following information: Regular Staffing #: RN RPN Unit Clerk Service Support Suppor t Actual Staffing #: RN RPN Unit Clerk Service Support Suppor t Agency/Registry RN: Yes No How many? Novice RN Staff on duty* Yes No How many? RN Staff Overtime: Yes No If yes, how many staff? *as defined by your unit/area/program. If there was a shortage of staff at the time of the occurrence, (including support staff) please check one or all of the following that apply: Absence/Emergency Leave Sick Call(s) Vacancies Off unit Management Support available on site? Yes No

WORKING CONDITIONS. In order to effectively resolve workload issues, please provide details about the working conditions at the time of o occurrence by providing the following information: Regular Staffing #: RN RPN Unit Clerk Service Support Actual Staffing #: RN RPN Unit Clerk Service Support Agency/Registry RN: Yes No How many? Novice RN Staff on duty* Yes No How many? RN Staff Overtime: Yes No If yes, how many staff? *as defined by your unit/area/program. If there was a shortage of staff at the time of the occurrence, (including support staff) please check one or all of the following that apply: Absence/Emergency Leave Sick Call(s) Vacancies Off unit Management Support available on site? Yes NoNo f

WORKING CONDITIONS. In order to effectively resolve workload issues, please provide details about the working conditions at the time of occurrence by providing the following information: Regular Staffing #: RN RPN Unit Clerk Service Support Suppor t Actual Staffing #: RN RPN Unit Clerk Service Support Suppor t Agency/Registry RN: Yes No How many? Novice RN Staff on duty* Yes No How many? RN Staff Overtime: Yes No If yes, how many staffmanystaff? *as defined by your unit/area/program. If there was a shortage of staff at the time of the occurrence, (including support staff) please check one or all of the following that apply: Absence/Emergency Leave Sick Call(s) Vacancies Off unit Management Support available on site? Yes No

WORKING CONDITIONS. In order to effectively resolve workload issues, please provide details about the working conditions at the time of occurrence by providing the following information: Regular Staffing #: RN   RPN   Unit Clerk   Service Support   Actual Staffing #: RN   RPN   Unit Clerk   Service Support   Agency/Registry RN: Yes No How many?   Novice RN Staff on duty* Yes No How many?   RN Staff Overtime: Yes No If yes, how many staff?   *as defined by your unit/area/program. If there was a shortage of staff at the time of the occurrence, occurrence (including support staff) ), please check one or all of the following that apply: Absence/Emergency Leave Sick Call(s) Vacancies Off unit Management Support available on site? Yes No

WORKING CONDITIONS. In order to effectively resolve workload issues, please provide details about the working conditions at the time of occurrence by providing the following information: # Regular Staffing #Staff: RN Support RPN Unit Clerk Service Support # Actual Staffing #Staff: RN Service Support RPN Unit Clerk Service Support Agency/Registry RN: RN Yes No How many? Novice RN Staff on dutyJunior Staff* Yes No How many? RN Staff Overtime: Yes Hours No No No How many? How many? If yes, how many staff? Total *as defined by your unit/area/program. If there was a shortage of staff at the time of the occurrence, (including support staff) please check one or all of the following that apply: Absence/Emergency Leave Sick Call(s) Vacancies Off unit Management Support available on site? Yes NoVacancies

WORKING CONDITIONS. In order to effectively resolve workload issues, please provide details about the working conditions at the time of occurrence by providing the following information: Regular Staffing #: RN RPN Unit Clerk Service Support Actual Staffing #: RN RPN Unit Clerk Service Support Agency/Registry RN: Yes No How many? Novice RN Staff on duty* Yes No How many? RN Staff Overtime: Yes No If I f yes, how many staff? *as defined by your unit/area/program. If there was a shortage of staff at the time of the occurrence, (including support staff) please check one or all of the following that apply: Absence/Emergency Leave Sick Call(s) Vacancies Off unit Management Support available on site? Yes No

WORKING CONDITIONS. Date/ Time notified: Click to enter date In order to effectively resolve workload issues, please provide details about the working conditions at the time of occurrence by providing the following information: Regular Staffing #: RN RPN Unit Clerk Service Support Actual Staffing #: RN RPN Unit Clerk Service Support Agency/Registry RN: Yes No How many? Novice RN Staff on duty* Yes No How many? RN Staff Overtime: Yes No If yes, how many staff? *as defined by your unit/area/program. If there was a shortage of staff at the time of the occurrence, (including support staff) please check one or all of the following that apply: Absence/Emergency Leave Sick Call(s) Vacancies Off unit Management Support available on site? Yes No

WORKING CONDITIONS. In order to effectively resolve workload issues, please provide details about the working conditions at the time of occurrence by providing the following information: Regular Staffing #: RN RPN Unit Clerk Service Support Actual Staffing #: RN RPN Unit Clerk Service Support Agency/Registry RN: Yes No How many? Novice RN Staff on duty* Yes No How many? RN Staff Overtime: Yes No If yes, how many staffmanystaff? *as defined by your unit/area/program. If there was a shortage of staff at the time of the occurrence, (including support staff) please check one or all of the following that apply: Absence/Emergency Leave Sick Call(s) Vacancies Off unit Management Support available on site? Yes No

WORKING CONDITIONS. In order to effectively resolve workload issues, please provide details about the working conditions at the time of occurrence by providing the following information: # Regular Staffing #Staff: RN RPN Unit Clerk Service Support # Actual Staffing #Staff: RN RPN Unit Clerk Service Support Agency/Registry RN: RN Yes No How many? Novice RN Staff on dutyJunior Staff* Yes No How many? RN Staff Overtime: Yes No No No How many? How many? If yes, how many staff? Total Hours *as defined by your unit/area/program. If there was a shortage of staff at the time of the occurrence, (including support staff) please check one or all of the following that apply: Absence/Emergency Leave Sick Call(s) Vacancies Off unit Management Support available on site? Yes NoVacancies