protech EMPLOYEE update

of DETAILS form

PERSONAL DETAILS
Last Name: / Code (Protech to fill in):
First Name: / Title: / Mr / Ms / Miss / Mrs / Dr
Address: / Suburb:
Postcode:
Home Phone: / Mobile:
Email: / * Please note by providing your email you are accepting that Pay Advice/ Payment Summary and all written letters will be sent by email as default, as part of our commitment to the environment and reducing waste.
BANKING/PAYROLL DETAILS
BANK ACCOUNT # 1 : BALANCE OF ALLOCATION TO THIS ACCOUNT
Bank Name: / Account Name:
BSB: / Account No:
BANK ACCOUNT # 2 : SET AMOUNT PER WEEK: / $
Bank Name: / Account Name:
BSB: / Account No:
SUPER DETAILS CHANGE
New Super Choice form may be required to verify fund compliance
Fund Name: / Fund Number:
Unique Superannuation Identifier (USI) Formerly known as SPIN
DEDUCTIONS
Not to include salary sacrifice for Super – need Salary Sacrifice Agreement
Extra Tax: / ______% or $ ______per week
Other Deduction Details: (to be approved) / ______% or $ ______per week
DISCLOSURE DECLARATION
Have you ever been charged, convicted by a court or dismissed from employment for an offence involving drugs, dishonesty and breach of trust, sexual harassment, violence, or any other Criminal offence? / Yes / No
MEDICAL INFORMATION
Has any of your Medical information/details or Next of Kin Contact changed since registration with Protech / Yes / No
If yes, we require a new declaration to specify your changed Medical information – please fill in Page 2 of this form.
CANDIDATE SIGN OFF
The details provided here are true and correct at the time of signing below. I agree to abide by all stated conditions of employment including policies and instruction, as advised by Protech or its representatives, when placed into an Assignment on behalf of Protech and acknowledge that I must notify them of any changes to my skills and details to ensure they are accurate.
Employee Signature: / Date:
PROTECH USE ONLY
WorkDESK update by Consultant: (LOAD SCAN) / Processed by Payroll: / Date:

* Notify via email - Payroll - changes to Page 1 / Safety - changes to Page 2. This Update of Details & Test for Drug & Alcohol required, when returning after 3 months absence or after any absence due to injury. New TFN needed if Centrelink Separation Certificate issued after last engagement.

Any absence greater than 6 months requires full re-registration on the standard application pack.

PERSONAL DETAILS
MEDICAL INFORMATION CONCERNING RISKS AT WORK
Do you have physical or psychological condition that may affect your capacity to work? / Yes / No / If yes, explain:
Do you, or have you had difficulties or pain associated with manual handling tasks involving lifting or carrying weights or body movements? / Yes / No / If yes, explain:
Do you experience pain in any body part? / Yes / No / If yes, explain:
INJURY HISTORY
To assist Protech to perform a risk assessment for your safe job placement, you must provide details of all your significant/major injuries and medical conditions that you have experienced (particularly musclo-skeletal).
Date Injury Occurred / Detail the types of injuries you experienced / How long have you experienced the injuries? / When did you fully recover from this?
NEXT OF KIN CONTACT
Name: / Relationship:
Emergency Home Ph: / Emergency Mobile:
MEDICATION
Do you, or are you required to take prescription drugs/medication before or during any work hours. / Yes / No / Name: / Dosage: / Reason:
Have you been vaccinated against any industry specific diseases (ie Hepatitis A or B, Q-fever)? / Yes / No / If yes, explain:
HEALTH CONDITIONS
Do you suffer from any types of allergies or respiratory conditions? / Yes / No / If yes, explain:
Please indicate by ticking to the left if you experience/suffer from any of these conditions or ever have difficulties with certain conditions:
Vision / Hearing / Walking/standing for extended periods
Pushing/Pulling Objects / Back injury / Pain problems / Lifting/carrying or moving weights
Working at any heights/Vertigo / Mild repetitive movements / Bending/twisting/turning
Literacy or Numerical basics / Substance Intolerance / Colour Blindness
Skin Disorders or Conditions / Respiratory Conditions / Pain Disorders
Blood Borne Diseases or Viruses / Shortness of Breath / Dizziness/Fainting
RSI/Carpal Tunnel / Stress/Anxiety/Attention Deficits / Physical Abilities
Use of your Shoulders/Arms/Wrists/Hands/Fingers/Knees/Ankles/Feet / Other conditions not stated
If you have ticked any of the above – please give details:
Do I require a Medical Management Plan to be established for anything declared above? / Yes / No
If yes, please provide one from a Medical Practitioner or request a Form - Medical Restrictions Management Plan (F_0035) from your Consultant to complete.
Doc # _Revision: / F_0034_F / Page 2 of 2
This is a Controlled Document as are all on TMS. Electronic and printed copies are not controlled, will not be updated and must be checked against TMS prior to use. / /
Doc Owner: / Quality
Approved: / AK/AH/NS – 30.05.14