Cheyenne Regional Medical Center / Staff / Employees / Kronos Login / On Call/LCD Forms

On Call/LCD Forms

Consent for Out of Turn On Call or LCD

Employee Name:*
Email:
I agree to be placed:*
- On Call
- On LCD
Today's Date:*
Current Time:

: Hours

Minutes

AM/PM

On Call/LCD Request Form

Request must be made 24 hours in advance of shift request.

Employee's Name:*
Email Address:*
Job Title:*
Department:*
Date Requesting On Call/LCD:*
Shift Requesting On Call/LCD (AM, PM, Day, Midshift, Evening Shift, Night Shift or Other):*
Today's Date:*
MM slash DD slash YYYY
Current Time:*

: Hours

Minutes

AM/PM