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Leave Application Form

This document is a leave application form for pharmacists in the Sultanate of Oman. It requests information about the pharmacist, their establishment, and their leave details. It notes requirements such as submitting the application 20 days before leave, limits on how long an establishment can be closed, temperature requirements, and documentation needed from replacement pharmacists or if transferring establishments. The form is to be signed by the sponsor and pharmacist and will be reviewed by the Supervising Pharmacist and Director of the Pharmacy Department for approval.

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RPh Krishna Chandra Jagrit
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© Attribution Non-Commercial (BY-NC)
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4K views2 pages

Leave Application Form

This document is a leave application form for pharmacists in the Sultanate of Oman. It requests information about the pharmacist, their establishment, and their leave details. It notes requirements such as submitting the application 20 days before leave, limits on how long an establishment can be closed, temperature requirements, and documentation needed from replacement pharmacists or if transferring establishments. The form is to be signed by the sponsor and pharmacist and will be reviewed by the Supervising Pharmacist and Director of the Pharmacy Department for approval.

Uploaded by

RPh Krishna Chandra Jagrit
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOC, PDF, TXT or read online on Scribd

Application No: / Date: / /

Leave Application Form

* This application must be submitted 20 days before proceeding for annual leave
A. Pharmacist details

A.1 Pharmacist’s name: _________________________________________________.


A.2 Registration No: ___________________________________________________.
A.3 Date of registration: / /
A.4 Expiry date (license): / /
A.5 Tel no: Mobile ______________________House:________________________.
E-mail __________________________________________________.
A.6 Resident card No___________________________________________________.
B. Pharmaceutical Establishment details

B.1 Name of the establishment: __________________________________________.


B.2 Registration No: __________________________________________________.
B.3 Branch / location _____ ______________________________________.
B.4 Contacts: Mail: P.O.Box:______ P.C: _______ Region: ________________.
Tel No/ Fax No of the Est / branch: __________________________.
E-mail: __________________________________________________.

C: Leave details

C.1: Expected leave date: / /


C.2: Expected date of return: / /
C.3 Period of the leave:_________________________________________________.

C.4: Type of Leave: *annual sick urgent


C.5: Status of the establishment during the leave:
Closed

Run by a replacement (Pharmacist / Asst. Ph) ( if so, please fill the following) :
Name of the person taking over the charge:______________________________.
Designation (Pharmacist/ Asst. Pharmacist): ______________Reg. No: ________
Date of registration: / /
Expiry date ( license): / /
If from different establishment:
Name of the establishment:__________________________________________.
Establishment address/ location:______________________________________.
Tel No:__________________Fax No:__________________________________.
If from the same establishment:
Branch______________________Address:________________________________.
Tel No:______________________Fax No:________________________________.
Application no: /

D: General

1. If the pharmaceutical establishment remain closed during the leave:

A. It should not be closed for more than (3) months continuously, otherwise its
license will be cancelled without any notice ( As per Article (10C) of the Royal
Decree No 41/96.
B. Temperature inside the pharmacy should not exceed 24ºC ( i.e. the AC should
be left working) ( As per Para (5) ) Article ( 8) of the Ministerial Decision No
74/2000.
C. If an assistant pharmacist takes over the charge, he/she is not authorized to
handle / dispense narcotics or psychotropic drugs.
2. Inform the Pharmacy Dept. as soon as the Pharmacist resumes his duties.
3. The application will not be proceeded unless the sponsor has signed it.
4. In case of any delay to resume duty, the Pharmacy Department should be
notified as soon as possible accompanied with the reason (s) for that delay.
5. In case of replacement from a different establishment, a No Objection letter
from the sponsor of that establishment is required.

Sponsor’s signature: Pharmacist signature/ Stamp


E: Official Use
E.1 SH ( Pharmacist & Asst. Pharmacist) comments:
- To grant the leave for a period of :
- Postponed it till: / /

E.2 Director of Pharmacy Department Decision:


_____________________________________________________________________________________________________
____________________________________________________________________.

E.3 Letter No :DPD/


Date: / /
E.4 Pharmacist resumes duty on: / /

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