Glenside Afterhours Roster

Your answers are confidential

Only the roster organiser sees your responses.
Nothing is sent until you review and submit.
Your contact details are shared with Glenside switchboard only, as an on-call backup.

• 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

Used only by Glenside switchboard to reach you 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 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.