Staff leavers form

Please complete the relevant Staff Leaver form from the list of organisations below.

Midlands and Lancashire CSU employees please continue to use our own form - ML Leavers form

Birmingham and Solihull ICB (BSOL) employees and associated GP practices: Birmingham and Solihull ICB Leavers form

Black Country ICB employees and associated GP practices: Black Country ICB Leavers form

Cheshire and Merseyside ICB employees: Cheshire & Merseyside ICB Leavers form

East Cheshire Trust employees: East Cheshire Trust Leavers form

Lancashire and South Cumbria ICB employees and associated GP practices: Lancashire & South Cumbria ICB Leavers form

Other Cheshire Warrington and Wirral Clients (including GP): Other Cheshire Warrington and Wirral Clients Leavers form

Shropshire, Telford and Wrekin ICB employees and associated GP practices: Shropshire, Telford and Wrekin ICB Leavers form

Worcester (SWHC) employees and associated GP practices: Worcester (SWHC) Leavers form

The Leavers smartform can be used to request termination/suspension of the following:

  • Windows
    • Domain accounts
    • Shared drive/folder access
    • Remote access
  • NHS Mail
    • Disabling/deleting accounts
    • Accounts to be marked as a leaver
  • Sostenuto contact record and self-service access
  • ID/swipe card access to some Cheshire buildings
  • Phone system access
  • Handing back/reassigning existing IT equipment

Once you have completed the form, it will then log your request and you will receive the standard email with the details and your call reference. Depending on the access removal required, you may receive multiple call reference numbers, as some requests go to different teams – this will ensure that the calls get to the relevant team at the point of submission, and that nothing gets missed from your request.

Finally as normal; when the call is updated or resolved, you will receive the normal update emails or you can check the status of your request via the Self Service Portal. Should you need guidance using the Self Service Portal, please see our instructions here.