DITP Need Request Form

DITP Need Request Form

Todays Date*

Managers Name*

Email Address*

Phone Number*

Phone

Unit/Dept*

Entity*

Select or enter value

Proposed Start Date*

Number of Individuals requesting*

Shift Requesting Coverage for*

Select

If selected other please provide details below

Is this request for a new start?*

YES

If requesting an Extension Provide RN's Name

*Please Note: RN's can only have one extension on Unit.

The answers to the following questions related to the list below; are needed to assist with allocating our resources of ITP RN's:

Budgeted FTE*

Functional Vacancy rate?*

What is your functional Vacancy rate for period requesting coverage?

FTE's*

What is your current number of filled fte's?

Number of employees presently in Orientation*

Number of employees on Continuous FMLA*

Additional Comments

Send me a copy of my responses

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