<p> CRISSP & (CRIS for CCM) User Registration/Update Form</p><p>Please complete all sections and attach this template to an email addressed to [email protected] with the subject “CRISSP User Update Form”.</p><p>First Name Last Name Agency Name Agency Phone Worker Email Worker Primary Address Do you need a NEW CRISSP Role (Security YES / NO Profile)? If yes, Please select ONE only, with the Manager CEO exception of QDC Rpt CRISSP Program Manager</p><p>If new role is not required please select NO. CRISSP Self Registration Authorisation (Additional)</p><p>Administrative Worker CRISSP Administration Worker CRISSP Senior Administration Support CRISSP Trans Administration (Additional) CRISSP Trans No Administration (Additional) CRISSP Admin Switch User (Additional)</p><p>Disability Services CRISSP DS Case Manager CRISSP DS Intake Worker CRISSP DS QDC Report (Additional) CRISSP DS Residential Supervisor CRISSP DS Residential Worker CRISSP DS Team Leader CRISSP QDC Administrator</p><p>ECIS Services CRISSP ECIS Case Manager CRISSP ECIS Intake Worker CRISSP ECIS Team Leader</p><p>Placement and Support Services CRISSP On Call Worker CRISSP P&S Case Manager CRISSP P&S Intake Worker CRISSP P&S Residential Supervisor CRISSP P&S Residential Worker CRISSP P&S Team Leader</p><p>Generic Services CRISSP Generic Case Manager CRISSP Generic Intake Worker CRISSP Generic Team Leader</p><p>Youth Services CRISSP Youth Case Worker CRISSP Youth Team Leader</p><p>CRIS Only – Contracted Case Worker CRIS Only – Contracted Case Supervisor CRIS Only – AFDM Co Convenor Worker</p><p>Do you need a NEW CRIS Role (Security NO Profile)? CP Contracted Worker If yes, Please select ONE only; If no, please CP Contracted Supervisor select NO. CP - AFDM Co Convenor Worker</p><p>For further information, please contact: [email protected] Name of your Supervisor/Team Leader</p><p>DHS Region Barwon South West Select ONE only; Eastern Metro Gippsland Grampians Hume Loddon Mallee North West Metro Southern Metro ADD to the following Provider Group/s for CRISSP. ie. Anglicare Gippsland HBC Complex </p><p>(Please indicate if you are the Team Leader of the Provider Group. This will ensure you receive referrals on your worklist and can authorise the alerts created by your workers in CRISSP. ie. Anglicare Gippsland HBC Complex (TL) ADD to the following Provider Group/s for CRIS.</p><p>REMOVE from the following Provider Group/s for CRISSP. </p><p>REMOVE from the following Provider Group/s for CRIS.</p><p>Manager authorising this application?</p>