Hospital Staffing Plan Submission Form

Hospital Staffing Plan Submission Form

Under ORS 441.763, OHA is required to post hospital staffing plans submitted by the hospital.

Submit ALL of one type of hospital staffing plan as a single file. For example, if you select Professional/Technical Staffing Plan, combine all Professional/Technical Staffing Plans for the hospital into a single file and upload that file in the section below.

Name of person completing this form*

Title of person completing this form*

Email of person completing this form*

Phone of person completing this form*

Phone

Hospital*

Select

What type of hospital staffing plan is being submitted?*

Nurse Staffing Plan

Professional/Technical Staffing Plan

Service Staffing Plan

Instructions for submitting Hospital Staffing Plans

This form is to be used to submit hospital staffing plans.

Include ALL of the type of hospital staffing plan referenced above (e.g., submit all Nurse Staffing Plans i.e., plans for every unit where nursing care services are provided, in a single file if you selected "Nurse Staffing Plan" above). Do not submit only one plan, unless there is only one plan in use for the entire hospital. Do not submit multiple types of hospital staffing plans at once (e.g., do not combine Nurse Staffing Plans, Professional/Technical Staffing Plans, and Service Staffing Plans in a single file).

Click below to upload the type of hospital staffing plan referenced above as a single PDF*

Drag and drop files here or

Check here to confirm that the file uploaded contains all the Professional/Technical Staffing Plans created by the Professional/Technical Staffing Committee*

Check here to confirm that the file uploaded contains all the Service Staffing Committee Plans created by the Service Staffing Committee.*

Check here to confirm that the file uploaded contains all the Nurse Staffing Plans adopted by the Nurse Staffing Committee.*

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