Electronic Changeover Form

James Cook University Hospital

This form should be used for the August 2025 rotation reflecting dates from 06/08/25 to 03/02/26.

About You

Personal Details

Please specify an NHS.net email address
Optional

Emergency Contact Details

Professional Details

Optional

Photo

Training History

Training Details

Optional
Training Milestones Complete

Training Planning

Rotation Goals

Optional
Optional
Optional

Cardiac Anaesthesia

Neuro Anaesthesia

Paediatric Anaesthesia

Future Rotations

If you know which departments you will be rotating to within your stage of training, please select them below:










Rota Planning

Working Pattern

Optional
If Less Than Full Time, Please Select Preferred Non-Working Days:




Placement Adjustments

Are You Returning After A Period Of Absence?
Do You Require Workplace Adjustments?
Placement Adjustments

If you have answered yes to either of the questions above please contact the college tutor directly.

Last Out-Of-Hours Shifts

Please provide the dates of your last out of hours shifts in the current rotation.

Rota Planning Comments

Please provide any comments you would like to make about your rota planning.

Leave and Not-On-Call Requests

Once submitted you will not be able to modify or update this changeover form.