T05 Job planning discussion record — Blank form
2026 digital edition · Dr Naeem Aziz DGM FRCP · 1 min read
Print this blank worksheet and complete it privately. Responses are not collected by the website. Do not include identifiable patient information. This is a planning aid, not an official application form.
Blank reusable form
Read with chapter 8
Prepare the job-plan request using the worked wording in chapter 8. Separate the applicable contract, professional guidance and your proposed arrangement.
Activity and purpose
Explain the clinical, development or wider professional task.
Present arrangement
Record actual frequency, preparation, delivery, follow-up and existing allocation.
Requested change
Describe the time, responsibility or support to be considered.
Effect on other work
Identify displaced work, cover and any effect on colleagues.
Basis of the request
Distinguish contract, guidance, agreed role requirement and individual proposal.
Decision and owner
Record agreed, declined or pending, with reasons and the authorised decision maker.
Review and unresolved matters
Record a date, evidence to review and the route for outstanding questions.