Glenside Afterhours Roster

Your answers are completely confidential

Responses are kept confidential — seen only by the roster organiser.
Nothing is sent until you review and submit at the end.
Your contact details go to Glenside switchboard only, as a backup to the on-call phone.

• About you

First name *

Please enter your first name.

Surname *

Please enter your surname.

Your role / level *

Please select your role.

Primary workplace (ward) *

Please select your ward.

Please specify your workplace

Please specify your workplace.

1 Contact details

Shared with Glenside switchboard only, as an on-call backup.
Not passed to any other service (wards, etc.).

Mobile number *

Please enter a contact number.

Enter a valid email address.

Alternate contact — optional (e.g. pager, landline)

2 Registration limitations

Any conditions on your AHPRA registration that would prevent you participating in this roster?

Yes — there are limitations on my registration

Please describe briefly

3 EPAS training

Have you completed EPAS training?

EPAS training completed

If not completed, current status *

Please select your EPAS status.

4 FTE status

Your current full-time-equivalent, from 0 to 1.0. If less than 1.0, tell us which weekdays you are not rostered to work.

FTE *

Enter an FTE between 0 and 1.0.

5 Extra shifts

Would you be interested in taking more than the minimum number of shifts?

Yes — I'm happy to take more than the minimum

How many extra shifts per month would you like? — optional

Any days you'd prefer for the extra shifts? — optional

6 Training afternoon

For registrars and TAPPP RMOs — which afternoon is your protected training time? Select one. *

7 Examinations

Have you applied to sit any examinations during this period?

Yes — I've applied to sit exam(s) during this period

Which exam(s)?

Exam date — if known

8 Approved leave

Leave (annual, study, or professional development) already approved by your supervisor and clinical director. Add a row for each block.

9 Planned leave (pending approval)

Leave you have planned but that is not yet approved.

10 Other requests

Anything else the roster should take into account? Keep it brief.

Glenside Hospital · Afterhours junior doctor roster · If you have trouble with this form, reply to the admin email instead.