Health Improvement Resource Service

NHS Forth Valley

LIBRARY CLIENT REGISTRATION FORM

All potential clients of the Health Improvement Resource Service (HIRS) are required to complete this form. The Service is available to anyone involved in health promotion work in the Forth Valley area including Community and Voluntary Organisations, Local Authority Staff, NHS Forth Valley Staff, Workplaces, Colleges and University.

We offer access to the HIRS Library, which can be visited by all registered HIRS clients in the Forth Valley area. The Library provides access to information on many health promotion topics, and in a range of formats, most of which may be borrowed (e.g. DVDs, teaching kits, books, games and models).

Registered clients may also search our resources and materials collections online at: www.shelcat.org/vl

Clients can also come along to the Look ‘n’ Book sessions to view resource samples and discuss resource requirement with a member of staff. Orders for resources, including leaflets, posters, condoms and borrowable resources can be placed at the same time. Dates for Look ‘n’ Book sessions are available from the HIRS Newsletter.

Visits can be arranged by phoning 01786 433867

Client Barcode (to be allocated) Client Password (to be allocated) Patron ID (office use only)

Please complete the form as fully as possible and in BLOCK CAPITALS.

Title (Mr, Mrs, Ms etc) First Name (s) Surname Occupation (from list) Organisation (from list) Primary Contact Address: Alternate address (optional):

Phone Mobile Fax Email Address Mailshot Preference HIRS is continually developing its services and resources. Periodically, we may wish to send you information on these developments. Please indicate if you would like to receive this type of information by placing a tick in the relevant box.

Yes □ No □

Essential service information (e.g. building closures, change of hours, etc) which we consider should be communicated to all library clients will usually be posted on our website. *please turn over* Declaration

By signing this declaration, you are acknowledging that you have read and understand the Terms & Conditions of Service that accompany this form.

I have read the terms and conditions of service and agree to abide by then when borrowing/accessing resources or materials from NHS Forth Valley.

DATA PROTECTION ACT 1998: The information you provide on this form shall be kept in a secure, manual filing system and on a computer on the library premises. In addition, this data will be entered into the Aleph Library Management System (LMS) in order to administer your library account. The Aleph LMS is managed by NHS Education for Scotland and held securely on a single database server at Atos Origin, 1 Appleton Place, Appleton Parkway, Livingston, EH54 7EZ. System security has been approved by NHS National Services Scotland.

Your information is confidential and will only be accessed by:

o Library staff throughout NHS Scotland and partner health services using the ALEPH LMS in order to facilitate effective library service provision across all Board and institutions. Under no circumstances will personal data be used for any other purpose than library service provision, will not be given to any third parties, and will not be transferred onto any other library system without your consent.

o Health Promotion staff within NHS Forth Valley

You may access the information we hold on you directly via the web at: www.shelcat.org/vl (My Account). Alternatively, you may call in person to HIRS during normal office hours, or send a written request for reply within four working days upon receipt, to the address below. If you agree to your information being held, please sign below.

Signature Date

Please send the signed and dated form to: Library Services Officer, Health Improvement Resource Service NHS Forth Valley Unit 2, Ground Floor Colquhoun Street Stirling FK7 7PX

After receiving and progressing your form, we will send you a copy of the agreement for future reference along with your new Shelcat Library Card, Client barcode, Password and Shelcat Quick-Start-Guide.

For Office Use Only Details Entered onto Computer Yes □ Client Barcode & Password Allocated Yes □ Shelcat Library Card issued to Client Yes □ Copy of Registration Form Returned Yes □ Shelcat Quick-Start Guide Yes □

Processed by: ………………………………………………..Date: ………………………………………….. TERMS & CONDITIONS OF SERVICE

We request that all registered Health Improvement Resource Service (HIRS) Clients undertake to abide by the following terms and conditions:

1. All potential Clients of HIRS must complete a Library Client Registration Form.

2. All Clients are entitled to use HIRS once they have registered and been issued with their Scottish Health Libraries Catalogue (Shelcat) Library Card.

3. Clients should inform HIRS staff promptly of any change to the personal or contact details on their registration form.

4. The Shelcat Library Card is issued for the use of the person named on it (the Client). It must not be lent, transferred or used by any other person.

5. The Client Barcode and Password issued on registration are for personal use only and must not be disclosed to others. These details should be held securely, as they allow access to Shelcat.

6. Clients should inform HIRS staff if their Shelcat Library Card is lost.

7. Bookings/orders can be made online via Shelcat or by sending HIRS details via the Health Promotion service website, email, internal mail, fax or post. Clients should aim to submit bookings/orders for events as far in advance as possible to ensure availability and that items are processed in good time.

8. Clients should allow a minimum of 5 working days from receipt of a resource booking for HIRS staff to process the booking. If items are not available for the dates requested, the Client should contact HIRS staff to discuss suitable alternatives.

9. A maximum of 10 items may be on loan to a client at any one time. All resources can be booked out for a maximum of 3 weeks. If Clients require an extension to the initial loan period, they should contact HIRS staff before the item(s) become overdue to see if any extension is possible. Items on loan can be renewed in person or by telephone.

10. Leaflet, poster and condom orders can take up to 7-10 working days to process from receipt of the order. The maximum quantity of each item supplied is currently 40 for a leaflet and 3 for a poster. However, a lower limit may be set at our discretion at any time.

11. Resources/materials can either be collected in person or be delivered to the following premises:

NHS Premises, Internal Mail

12. Clients should ideally preview all resources/materials before initial use as the information provided on Shelcat (e.g. abstract) is intended only as a guide.

13. Clients are personally responsible for any resource items loaned in their name until they are checked-in by HIRS staff. Clients are liable for the replacement of resources if lost or damaged whether by accident, negligence or theft/loss by a third party. Once an item is overdue:

- after 1 week, the Client will receive an email reminder - after 2 weeks, the Client will receive a second email reminder - after 3 weeks, the Client will receive a final email reminder advising they are liable for the full replacement cost if resource items are not returned immediately. If not returned, an invoice will be issued from Financial Services.

Clients are asked to respect the needs of fellow Clients and return resources as soon as possible and in any event within the stated loan period. This also helps HIRS staff to administer the service efficiently. 14. Clients should take precautions to ensure the safety and security of resources at all times:

15. Prior to returning borrowed resources, Clients should check to see that all parts are returned intact.

16. So far as is possible, all items are despatched in good working order and complete. If items are damaged or missing when you receive them, please let HIRS staff know as soon as possible.

17. Clients must observe appropriate copyright legislation and regulations in respect of all resources and materials, whether print, audio-visual or electronic, made available to them by the HIRS and Shelcat.

18. The Health Promotion Service reserves the right to change these terms and conditions but Clients will be notified of any such changes.

19. HIRS reserves the right to withdraw the registration of a Client if these terms and conditions are not complied with. OCCUPATION & ORGANISATION LIST FOR COMPLETING THE LIBRARY CLIENT REGISTRATION FORM

Occupation (please select one only and enter on form) * o Social Work o Speech & Language Therapy o Active Schools Co-ordination o Student o Business & Commerce o Training & Education o Child & Adolescent Mental Health o University & College staff o Children's Home o Voluntary Work Community Alcohol & Drugs Service o o Youth / Project Work o Community Development o Community Education * If your occupational group is not reflected in the above list, o Community Mental Health Team please suggest an additional term, on the form. o Community & Retail Pharmacy o Community Services Organisation o Counselling (please select one only and enter on form) * o Day Unit / Special School o Day / Family Centres * The organisational categories listed below are for our o Dental Health Education statistical purposes. The actual name of your organisation o Dental Therapy& Hygiene can appear in the Address box(es) on the form. o Dental Practice o Clackmannanshire - CHP o Dietetics (Community Health Partnership) o Doctor - General Practice o Doctor (not GP) o Clackmannanshire Community Healthcare Centre o Education Advisory Service o Environmental Health o Clackmannanshire - Council o Family Planning Clinic o General Public - Courtesy o Clackmannanshire - Other organisation o Health Improvement Staff o Falkirk - CHP o Health Promotion Staff (Community Health Partnership) o Health & Safety o Health Visiting o Falkirk Community Hospital o Home Education o Hospital Pharmacy o Falkirk - Council o Hospital Staff – General o Human Resources o Falkirk - Other organisation o Learning Disabilities o Library & Information o Forth Valley Royal Hospital o New Community Schools o Forth Valley College – Stirling Campus o Nursing - Acute o Nursing - Community o Forth Valley College – Falkirk Campus o Nursing - Midwifery o Nursery School Staff o Forth Valley College – Clackmannanshire Campus o Occupational Health o Health Promotion Service o Occupational Therapy o Stirling - CHP o Paediatrics (Community Health Partnership) o Physiotherapy o Podiatry o Stirling Community Hospital o Police services Practice Management / Nursing o o Stirling - Council o Primary School Staff Prison Staff o o Stirling - Other organisation o Psychiatry If none of the above apply, please select: o Psychology o Public Health Consultancy & Practice o Forth Valley area o Radiography o Recognition Officer o Registered Charity o School Nursing o Secondary School Staff o Smoking Cessation