RRSSC Reconciliation Report

Teams must complete and submit the reconciliation report each Monday to the RRSSC. The weekly report should include all assignments that were filled over the past seven days (Monday-Sunday).

Please provide the following information for each assignment. If you are reporting more than 15 assignments, you will need to submit more than one form.

Facility Name(Required)

Facility Location(Required)

Voucher Number(Required)

Please rate your overall satisfaction with the Rapid Response Staffing Support Center?(Required)

Please enter a number from 1 to 5.

Any additional comments regarding the RRSSC that you would like to share with us?

Comments specific to assigned staff should be entered for each assignment below.

Assignment 1

Agency(Required)

Date of Shift(Required)

Hours Worked(Required)

If no call/no show or called in, enter 0 and select one of the radio buttons to the right.

Staff Member (First and Last Name)(Required)

Credential/Position(Required)

Please rate temporary staff member’s overall quality of work (1-5 scale)

Timeliness
Professionalism
Adherence to IC policies and procedures
Teamwork

Rating(Required)

Please enter a number from 1 to 5.

Would you request to work with this team member again?(Required)

If no, please explain.

Please rate your satisfaction with agency coordination to fill staffing needs.(Required)

Please enter a number from 1 to 5.

Assignment 2 - All fields required for each assignment

Agency

Date of Shift

Hours Worked

If no call/no show or called in, enter 0 and select one of the radio buttons to the right.

Staff Member (First and Last Name)

Credential/Position

Please rate temporary staff member’s overall quality of work (1-5 scale)

Timeliness
Professionalism
Adherence to IC policies and procedures
Teamwork

Rating

Please enter a number from 1 to 5.

Would you request to work with this team member again?

If no, please explain.

Please rate your satisfaction with agency coordination to fill staffing needs.

Please enter a number from 1 to 5.

Assignment 3 - All fields required for each assignment

Agency

Date of Shift

Hours Worked

If no call/no show or called in, enter 0 and select one of the radio buttons to the right.

Staff Member (First and Last Name)

Credential/Position

Please rate temporary staff member’s overall quality of work (1-5 scale)

Timeliness
Professionalism
Adherence to IC policies and procedures
Teamwork

Rating

Please enter a number from 1 to 5.

Would you request to work with this team member again?

If no, please explain.

Please rate your satisfaction with agency coordination to fill staffing needs.

Please enter a number from 1 to 5.

Assignment 4 - All fields required for each assignment

Agency

Date of Shift

Hours Worked

If no call/no show or called in, enter 0 and select one of the radio buttons to the right.

Staff Member (First and Last Name)

Credential/Position

Please rate temporary staff member’s overall quality of work (1-5 scale)

Timeliness
Professionalism
Adherence to IC policies and procedures
Teamwork

Rating

Please enter a number from 1 to 5.

Would you request to work with this team member again?

If no, please explain.

Please rate your satisfaction with agency coordination to fill staffing needs.

Please enter a number from 1 to 5.

Assignment 5 - All fields required for each assignment

Agency

Date of Shift

Hours Worked

If no call/no show or called in, enter 0 and select one of the radio buttons to the right.

Staff Member (First and Last Name)

Credential/Position

Please rate temporary staff member’s overall quality of work (1-5 scale)

Timeliness
Professionalism
Adherence to IC policies and procedures
Teamwork

Rating

Please enter a number from 1 to 5.

Would you request to work with this team member again?

If no, please explain.

Please rate your satisfaction with agency coordination to fill staffing needs.

Please enter a number from 1 to 5.

Assignment 6 - All fields required for each assignment

Agency

Date of Shift

Hours Worked

If no call/no show or called in, enter 0 and select one of the radio buttons to the right.

Staff Member (First and Last Name)

Credential/Position

Please rate temporary staff member’s overall quality of work (1-5 scale)

Timeliness
Professionalism
Adherence to IC policies and procedures
Teamwork

Rating

Please enter a number from 1 to 5.

Would you request to work with this team member again?

If no, please explain.

Please rate your satisfaction with agency coordination to fill staffing needs.

Please enter a number from 1 to 5.

Assignment 7 - All fields required for each assignment

Agency

Date of Shift

Hours Worked

If no call/no show or called in, enter 0 and select one of the radio buttons to the right.

Staff Member (First and Last Name)

Credential/Position

Please rate temporary staff member’s overall quality of work (1-5 scale)

Timeliness
Professionalism
Adherence to IC policies and procedures
Teamwork

Rating

Please enter a number from 1 to 5.

Would you request to work with this team member again?

If no, please explain.

Please rate your satisfaction with agency coordination to fill staffing needs.

Please enter a number from 1 to 5.

Assignment 8 - All fields required for each assignment

Agency

Date of Shift

Hours Worked

If no call/no show or called in, enter 0 and select one of the radio buttons to the right.

Staff Member (First and Last Name)

Credential/Position

Please rate temporary staff member’s overall quality of work (1-5 scale)

Timeliness
Professionalism
Adherence to IC policies and procedures
Teamwork

Rating

Please enter a number from 1 to 5.

Would you request to work with this team member again?

If no, please explain.

Please rate your satisfaction with agency coordination to fill staffing needs.

Please enter a number from 1 to 5.

Assignment 9 - All fields required for each assignment

Agency

Date of Shift

Hours Worked

If no call/no show or called in, enter 0 and select one of the radio buttons to the right.

Staff Member (First and Last Name)

Credential/Position

Please rate temporary staff member’s overall quality of work (1-5 scale)

Timeliness
Professionalism
Adherence to IC policies and procedures
Teamwork

Rating

Please enter a number from 1 to 5.

Would you request to work with this team member again?

If no, please explain.

Please rate your satisfaction with agency coordination to fill staffing needs.

Please enter a number from 1 to 5.

Assignment 10 - All fields required for each assignment

Agency

Date of Shift

Hours Worked

If no call/no show or called in, enter 0 and select one of the radio buttons to the right.

Staff Member (First and Last Name)

Credential/Position

Please rate temporary staff member’s overall quality of work (1-5 scale)

Timeliness
Professionalism
Adherence to IC policies and procedures
Teamwork

Rating

Please enter a number from 1 to 5.

Would you request to work with this team member again?

If no, please explain.

Please rate your satisfaction with agency coordination to fill staffing needs.

Please enter a number from 1 to 5.

Assignment 11 - All fields required for each assignment

Agency

Date of Shift

Hours Worked

If no call/no show or called in, enter 0 and select one of the radio buttons to the right.

Staff Member (First and Last Name)

Credential/Position

Please rate temporary staff member’s overall quality of work (1-5 scale)

Timeliness
Professionalism
Adherence to IC policies and procedures
Teamwork

Rating

Please enter a number from 1 to 5.

Would you request to work with this team member again?

If no, please explain.

Please rate your satisfaction with agency coordination to fill staffing needs.

Please enter a number from 1 to 5.

Assignment 12 - All fields required for each assignment

Agency

Date of Shift

Hours Worked

If no call/no show or called in, enter 0 and select one of the radio buttons to the right.

Staff Member (First and Last Name)

Credential/Position

Please rate temporary staff member’s overall quality of work (1-5 scale)

Timeliness
Professionalism
Adherence to IC policies and procedures
Teamwork

Rating

Please enter a number from 1 to 5.

Would you request to work with this team member again?

If no, please explain.

Please rate your satisfaction with agency coordination to fill staffing needs.

Please enter a number from 1 to 5.

Assignment 13 - All fields required for each assignment

Agency

Date of Shift

Hours Worked

If no call/no show or called in, enter 0 and select one of the radio buttons to the right.

Staff Member (First and Last Name)

Credential/Position

Please rate temporary staff member’s overall quality of work (1-5 scale)

Timeliness
Professionalism
Adherence to IC policies and procedures
Teamwork

Rating

Please enter a number from 1 to 5.

Would you request to work with this team member again?

If no, please explain.

Please rate your satisfaction with agency coordination to fill staffing needs.

Please enter a number from 1 to 5.

Assignment 14 - All fields required for each assignment

Agency

Date of Shift

Hours Worked

If no call/no show or called in, enter 0 and select one of the radio buttons to the right.

Staff Member (First and Last Name)

Credential/Position

Please rate temporary staff member’s overall quality of work (1-5 scale)

Timeliness
Professionalism
Adherence to IC policies and procedures
Teamwork

Rating

Please enter a number from 1 to 5.

Would you request to work with this team member again?

If no, please explain.

Please rate your satisfaction with agency coordination to fill staffing needs.

Please enter a number from 1 to 5.

Assignment 15 - All fields required for each assignment

Agency

Date of Shift

Hours Worked

If no call/no show or called in, enter 0 and select one of the radio buttons to the right.

Staff Member (First and Last Name)

Credential/Position

Please rate temporary staff member’s overall quality of work (1-5 scale)

Timeliness
Professionalism
Adherence to IC policies and procedures
Teamwork

Rating

Please enter a number from 1 to 5.

Would you request to work with this team member again?

If no, please explain.

Please rate your satisfaction with agency coordination to fill staffing needs.

Please enter a number from 1 to 5.

Comments

This field is for validation purposes and should be left unchanged.