HCS 600 HR WORK HUB Step 1 of 14 7% HCS 600 -HOME CARE ORGANIZATION PERSONNEL REPORTINSTRUCTIONS: Complete the below information for personnel working for/in the Home Care Organization, including all licensees, employees, volunteers, and Home Care Aides. An alternate document may be substituted in lieu of this form, if all required sections/information are provided in the same order. If personnel have multiple roles, please list all applicable per types. "Per Type" Definitions: L - Licensee, E - Employee/Volunteer, H - Home Care Aide.Home Care Organization Name Home Care Organization Number Home Care Organization Address Prepared By Date MM slash DD slash YYYY 1. Personnel ID (Per ID) 1. Per Type (L, E, H) 1. Date of Hire MM slash DD slash YYYY 1. First Name 1. Last Name **The following information is for HCAs only**1. Date of Registration MM slash DD slash YYYY 1. Date of Most Recent TB MM slash DD slash YYYY 1. All Training Hours Since Hire Date 2. Personnel ID (Per ID) 2. Per Type (L, E, H) 2. Date of Hire MM slash DD slash YYYY 2. First Name 2. Last Name **The following information is for HCAs only**2. Date of Registration MM slash DD slash YYYY 2. Date of Most Recent TB MM slash DD slash YYYY 2. All Training Hours Since Hire Date 3. Personnel ID (Per ID) 3. Per Type (L, E, H) 3. Date of Hire MM slash DD slash YYYY 3. First Name 3. Last Name **The following information is for HCAs only**3. Date of Registration MM slash DD slash YYYY 3. Date of Most Recent TB MM slash DD slash YYYY 3. All Training Hours Since Hire Date 4. Personnel ID (Per ID) 4. Per Type (L, E, H) 4. Date of Hire MM slash DD slash YYYY 4. First Name 4. Last Name **The following information is for HCAs only**4. Date of Registration MM slash DD slash YYYY 4. Date of Most Recent TB MM slash DD slash YYYY 4. All Training Hours Since Hire Date 5. Personnel ID (Per ID) 5. Per Type (L, E, H) 5. Date of Hire MM slash DD slash YYYY 5. First Name 5. Last Name **The following information is for HCAs only**5. Date of Registration MM slash DD slash YYYY 5. Date of Most Recent TB MM slash DD slash YYYY 5. All Training Hours Since Hire Date 6. Personnel ID (Per ID) 6. Per Type (L, E, H) 6. Date of Hire MM slash DD slash YYYY 6. First Name 6. Last Name **The following information is for HCAs only**6. Date of Registration MM slash DD slash YYYY 6. Date of Most Recent TB MM slash DD slash YYYY 6. All Training Hours Since Hire Date 7. Personnel ID (Per ID) 7. Per Type (L, E, H) 7. Date of Hire MM slash DD slash YYYY 7. First Name 7. Last Name **The following information is for HCAs only**7. Date of Registration MM slash DD slash YYYY 7. Date of Most Recent TB MM slash DD slash YYYY 7. All Training Hours Since Hire Date 8. Personnel ID (Per ID) 8. Per Type (L, E, H) 8. Date of Hire MM slash DD slash YYYY 8. First Name 8. Last Name **The following information is for HCAs only**8. Date of Registration MM slash DD slash YYYY 8. Date of Most Recent TB MM slash DD slash YYYY 8. All Training Hours Since Hire Date 9. Personnel ID (Per ID) 9. Per Type (L, E, H) 9. Date of Hire MM slash DD slash YYYY 9. First Name 9. Last Name **The following information is for HCAs only**9. Date of Registration MM slash DD slash YYYY 9. Date of Most Recent TB MM slash DD slash YYYY 9. All Training Hours Since Hire Date 10. Personnel ID (Per ID) 10. Per Type (L, E, H) 10. Date of Hire MM slash DD slash YYYY 10. First Name 10. Last Name **The following information is for HCAs only**10. Date of Registration MM slash DD slash YYYY 10. Date of Most Recent TB MM slash DD slash YYYY 10. All Training Hours Since Hire Date 11. Personnel ID (Per ID) 11. Per Type (L, E, H) 11. Date of Hire MM slash DD slash YYYY 11. First Name 11. Last Name **The following information is for HCAs only**11. Date of Registration MM slash DD slash YYYY 11. Date of Most Recent TB MM slash DD slash YYYY 11. All Training Hours Since Hire Date 12. Personnel ID (Per ID) 12. Per Type (L, E, H) 12. Date of Hire MM slash DD slash YYYY 12. First Name 12. Last Name **The following information is for HCAs only**12. Date of Registration MM slash DD slash YYYY 12. Date of Most Recent TB MM slash DD slash YYYY 12. All Training Hours Since Hire Date 13. Personnel ID (Per ID) 13. Per Type (L, E, H) 13. Date of Hire MM slash DD slash YYYY 13. First Name 13. Last Name **The following information is for HCAs only**13. Date of Registration MM slash DD slash YYYY 13. Date of Most Recent TB MM slash DD slash YYYY 13. All Training Hours Since Hire Date 14. Personnel ID (Per ID) 14. Per Type (L, E, H) 14. Date of Hire MM slash DD slash YYYY 14. First Name 14. Last Name **The following information is for HCAs only**14. Date of Registration MM slash DD slash YYYY 14. Date of Most Recent TB MM slash DD slash YYYY 14. All Training Hours Since Hire Date PhoneThis field is for validation purposes and should be left unchanged. 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