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Run: Agency Nurse First Shift Buddy Sign-Off

Use this first-shift buddy RN sign-off form to document an agency nurse’s readiness for independent assignment, capture support needs, and record any safety ...

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Shift and Assignment Details

Shift Date (required)

Unit or Department (required)

Shift Type (required)

Agency Nurse Identifier (required)

Use an employee, agency, or assignment identifier. Do not enter SSN or other unnecessary PII.

Buddy RN Name (required)

Readiness Assessment

Understands unit layout, workflow, and escalation path (required)

Demonstrated required clinical skills for the assignment (required)

Documentation was complete and accurate (required)

Communicated effectively and escalated concerns appropriately (required)

Followed unit policy, safety, and infection control requirements (required)

Observed Strengths and Support Needs

Observed strengths

Additional support or coaching needed

Any safety concerns observed? (required)

Safety concern details (required)

Final Buddy RN Sign-Off

Recommendation for independent assignment (required)

Follow-up actions required

Buddy RN Signature (required)

I confirm this sign-off reflects my direct observation during the first shift and uses only the minimum necessary information. (required)

Yes No N/A

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Email (required)

Your name (optional)

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