DBS check
request form	
		
Applicant’s name		
Title (eg.Mr/Mrs/Ms/Miss/Dr)		
Position		
Department		
Applicant’s email address*		
Applicant’s mobile phone number*		
* Please provide these details, which are necessary for Agenda to complete the check. Agenda will contact the individual directly to complete the check, and report the result back to the University. 

Before completing this form, please ensure you have read the information about eligibility for DBS checks on the HR web pages at https://www.recruitment.admin.cam.ac.uk/identify-screening-checks
If after doing so you are unsure about how to complete this form, please contact the Compliance Team via complianceteam@admin.cam.ac.uk (or the TES Manager for TES temp applications via (temps@admin.cam.ac.uk). 

Section A – Eligibility criteria

1.	Please review the table below and indicate which type of activity the applicant will be completing:
Type of Activity	Tick	Type of DBS check required	
Regulated activity with children	
Teaching, training, instructing, caring for or supervising children or providing advice/guidance on wellbeing or driving a vehicle solely for children – this is on a regular  basis and is not supervised.

Enhanced DBS check with children’s barred list check	
Engaged in work for, or in connection with, the purposes of a specified establishment (i.e. school, pupil referral unit, academies, nurseries, childcare premises, children’s detention centres, children’s homes, children’s centres) with the opportunity for contact with children – this is on a regular1 basis and may be supervised or unsupervised 2 above			
Working as a volunteer in a specified place (see above) with the opportunity for contact with children where this is on a regular1 basis and may be supervised or unsupervised2.			
Health care provided by, or under the direction or supervision of a regulated health care professional (please note that this only needs to be on one occasion to be regulated activity).			
Personal care involving hands-on physical assistance with washing and dressing, eating, drinking and toileting; prompting and supervising a child with any of these tasks because of their age, illness or disability; or teaching someone to do one of these tasks (please note that this only needs to be on one occasion to be regulated activity).			
Regulated activity with adults	
Healthcare0 provided by, or under the direction/supervision of a regulated health care professional.
		
Enhanced DBS check with adults’ barred list check, even if the role holder will only carry out the activity once	
Personal care for adults involving hand-on physical assistance with washing and dressing, eating, drinking and toileting; prompting and supervising an adult with any of these tasks because of their age, illness or disability; or teaching someone to do one of these tasks.
			
Conveying adults for reasons of age, illness or disability to, from, or between places, where they receive healthcare, personal care or social work arranged via a third party (not family/friends).
			
Supervising regulated activity	
Day-to-day management or supervision of any person engaging in any of the regulated activities listed above.		Enhanced DBS check with appropriate barred list check	
Formerly regulated activity	
Does the role involve activities which were deemed to be regulated activity before the coming into force of Section 64 of the Protection of Freedoms Act on 10 September 2012?
		Enhanced DBS check with no barred list check	
Healthcare (where not carrying out regulated activity)	
Employment or other work concerned with the provision of health services and which is of a kind as to enable the individual concerned to have access to persons in receipt of such services (i.e. people in receipt of health care 3) in the course of his/her normal duties.
		Standard DBS check	
If the above statement does not apply but you believe that the role is eligible for a DBS check, please consult the DBS’s eligibility guidance at https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/260319/DBS_guide_to_eligibility_v2.2.pdf and provide the eligibility reference number in the box on the right.
		Seek guidance from the Compliance Team	
2.	(a) Taking into account to the eligibility criterion you have indicated above, please describe the exact nature of the applicant’s work
What will they be doing? e.g. providing healthcare, teaching, training, instructing, observing, providing advice/guidance		
Who will they have contact with? e.g. children, adults, or both		
Is the applicant providing healthcare?	Yes
	 Go to question 3 	No
	 Answer the questions in the table below	

If applicable, are they patients, or healthy volunteers (if volunteers are they receiving healthcare?), if adults are they vulnerable adults and in what capacity)?		
How often? e.g. 4 or more times in 30 day period OR overnight		
Will they be supervised whilst undertaking the activity? If yes, how often? 		
 Go to Section B	

3.	Applicants providing healthcare only: please provide the following details in the box below:
•	What type of healthcare will they provide?
•	Is the applicant acting under their direction/supervision of a regulated healthcare professional or are a healthcare professional themselves. 
•	Is the work for research purposes only?
•	Will activities have a direct impact on patient care?
•	Will the applicant have direct and intended (i.e. non-incidental) contact with the patient?

4.	Is the DBS check required as part of a research passport application or honorary contract with an NHS Trust?
 Yes	
 No

If yes, please provide the required details in the box below. If no, please go to Section B.

Name of NHS Trust:
Name and contact details of NHS Trust contact for research passport application:

Details of any advice received from NHS Trust about the level of check they advise:

Section B – About the applicant
What is the status of the applicant being checked? 
 New employee  							(Go to Section C)   
 Temporary Employment Service (TES) temporary worker		(Go to Section C)   
 Other temporary worker or contractor					(Go to Section C)   
 Volunteer      								(Go to Section E)   
 Existing employee transferring to a role that requires a DBS check 	(Go to Section C)
 Existing employee being rechecked					(Complete box below)	

Date of last DBS/CRB check:
Level of check:
Reason for a recheck:

Section C – Payment for DBS check
The cost of a standard DBS check is £18, and an enhanced check costs £38. In addition to these costs there is an administration fee of £14.50 as all DBS checks are undertaken by Agenda Screening services, who act as the University’s ‘umbrella body’ for these checks.

Please provide the complete departmental cost code or details of a research grant to which payment for the DBS check will be charged. We cannot process this application without costing information. 
Research Grants							
Project Code (e.g. AAAG/001)	Task (e.g. 01)	Award 
(e.g. RG12345)	Expenditure Type
(e.g. misc/other costs)	
	/					
Account Code
Cost Code. 
       Dpt     CC       SOF     TRANS     
E.g.    AA        AABA       ECAA          ABAE         0000	
U					0000	
Section D – Risk assessment 
You can choose to allow the individual to start work before the outcome of the checks are known. This will require final approval from the Immigration and Compliance Manager/TES Manager.
•	What risk minimisation measures will be put in place until the outcome is known?	
Please tick as applicable:
 The applicant will not carry out any of the duties that require a DBS check 
 The applicant will not start employment/visit at the University before you know the outcome of their check
 The applicant will be supervised at all times when carrying out any duties that require a DBS check
 The existing employee will not transfer to the new role requiring the DBS check before you know the outcome of their check
 The existing employee will not start the activities relating to the DBS check before you know the outcome of their check
 Additional and/or other measures – please provide details below:	

•	Has the individual disclosed any criminal convictions, cautions, reprimands, warnings or pending police investigations? 	
 Yes - please contact HR Compliance Team (or TES if applicable)
 No - go to next question	

Have you obtained references in line with University policy? (If TES worker – TES to complete)	
 Referees declare applicant unsuitable – High Risk
 Referees share some reservation or no references obtained – Medium Risk
 Referees declare applicant suitable – Low Risk
 Not applicable – current employee	

Section E – Line Manager Confirmation

Line Manager Confirmation
I confirm that the information provided in this form is complete and accurate and that I will ensure that the risk minimisation measures specified above will be implemented. (This must not be completed by the administrator).	
Name		
Job title		
Signature		
Date		

ID DOCUMENTS:

Please note, The Disclosure and Barring Service (DBS) have introduced a new digital identity (ID) verification process for the purpose of verifying an individual’s identity, as part of an application for a DBS (Enhanced and Standard) check. In line with the latest DBS ID checking guidelines, Agenda Screening Services have recently introduced YOTI.  

The individual will be required to upload documentation and provide a live facial image for verification, confirming their ID and current address information, removing the DBS requirement for the physical documents to be checked with the person present.

If it is not possible for the individual to use this system, you will then be contacted to complete the three ID checks in person:

Documents you need for a criminal record check: You're from the UK or the European Economic Area - GOV.UK (www.gov.uk)

Section F – Where to send this form 

Status of Applicant	Where to send	
Employee	If you used Web Recruitment for the vacancy, this form and a copy of the passport can be uploaded into the system. 

If you did not use Web Recruitment, this form must be sent to the HR Compliance Team by email: ComplianceTeam@admin.cam.ac.uk 
	
TES worker	This application form must be sent to TES by email: temps@admin.cam.ac.uk

Section G – Central HR Approval 
Please complete the following only where Section D has been completed 
 The information provided by the department/institution has satisfied me that allowing the applicant to start work before his/her DBS check is completed is low risk and may proceed.
 The information provided by the department/institution has not satisfied me that allowing the applicant to start work before his/her DBS check is completed is low risk. The applicant may not commence employment until a satisfactory DBS check outcome has been received.

Name		
Title		
Signature		
Date