Bank Membership Passport - Harrow Health CIC

Section 1 – Employee details

Name*

First Last

Trading Status*

Role applying for*

Company Registration Number*

Name of Limited Company*

Registered Address*

Date of Birth*

Email*

Address*

Street Address City Post Code

Employing Harrow GP Practice*

If other, please state GP Practice*

NMC PIN (if applicable)

GMC Number (If applicable)

The above employee of your GP Practice has applied join the Harrow Health Bank to support the delivery of COVID vaccination clinics. In order for them to start work, we need you to complete this Bank Membership Passport to verify that all relevant compliance checks have taken place as permitted by the Collaboration Agreement your GP Practice has entered into in accordance with the NHSE Enhanced Services Specification for COVID Vaccinations.

Notes for completion: Complete all sections of this Passport in as much detail as possible. Even where an employee isn’t required to have specific skills or training as part of their role, please provide those details in the relevant sections as they may be able to perform other activities within the vaccination clinics.

Bank Membership Passport for Harrow Health Bank

Step 1 of 5

Section 1 – Employee details

Employment Checks

Immunisation Record

Competency Checklist