DBS Status Check Request 	

Applicant name		
Position		
Department		

You must only complete this form if the applicant has confirmed that they have subscribed to the DBS Update Service. Before completing the form, please ensure you have read the information about eligibility for DBS checks on the HR web pages at http://www.admin.cam.ac.uk/cam-only/offices/hr/recruitment/checks/disclosure.html#types. If after doing so, you are unsure what to do, please contact the Compliance Team via complianceteam@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	
Healthcare3 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 care3) 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 provide 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.	
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		
      
If the applicant will be providing healthcare, please go to question 3, otherwise please answer the questions in the table below

Who will they have contact with? e.g. children, adults, or both		
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 a 30 day period (frequently)		
Will they be supervised day-to-day and how regularly will they be supervised? 		
Go to Section B
3.	If the applicant is providing healthcare, 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  							 
 Temporary Employment Service (TES) temporary worker		 
 Other temporary worker or contractor					 
 Volunteer     								 
 Existing employee transferring to a role that requires a DBS check 	
 Existing employee being rechecked					

Section C – re-check information
Please ask the applicant to provide you with an original copy of the DBS Certificate he/she received when subscribing to the DBS Update Service and to present original identity documents to you which meet the DBS’s requirements (see https://www.gov.uk/government/publications/dbs-identity-checking-guidelines/id-checking-guidelines-for-dbs-check-applications-from-3-september-2018)
Name on DBS Certificate		
Date of birth on DBS Certificate		
DBS Certificate reference number		
Level of DBS check conducted
Please note: an online DBS check can only be completed if this is the same level of check as you stated is required now (see Question 9).	 Enhanced with adults’ barred list check
 Enhanced with children’s barred list check
 Enhanced with adults’ and children’s barred list check
 Enhanced with no barred list check
 Standard	
Department/institution declaration	I confirm that:
•	I have checked the applicant’s identity, in accordance with the DBS guidelines found at https://www.gov.uk/criminal-record-check-documents
•	I have reviewed the DBS’s information on DBS certificate security features (found at https://www.gov.uk/disclosure-barring-service-check/tracking-application-getting-certificate) and, to the best of my knowledge, I have seen an original copy of the applicant’s DBS certificate. 
•	The name on the certificate matched the original identity documents I have reviewed.
•	The information provided in this form is complete and accurate.	
	Name:		
	Title:		
	Signature:		
	Date:		
			
Applicant consent
Please note: this must be completed by the applicant only.	I confirm that I give the University of Cambridge my consent to complete a DBS status check on the DBS’s Update Service, using my details provided above.	
	Signature:		
	Date:		

Please note: if the applicant (or their disclosure certificate) has disclosed any criminal convictions, cautions, reprimands, warnings or pending police investigations, please also complete the HR20 Objective Assessment of a Criminal Conviction form (found at http://www.admin.cam.ac.uk/cam-only/offices/hr/forms/hr20/). 

Section D – Where to send the application

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: temporaryemploymentservice@admin.cam.ac.uk