Liquid Logic Systems User Access Agreement

Form for External Agencies
Trafford’s CFW and Adult Social Care Services holds details of Children, Adults and Families in Trafford within its systems. Much of this information is personal and of a sensitive nature. This information has been provided to us for the sole purpose of CFW and Adult Social Care administration. We therefore have a duty to ensure that we use and control this data properly in accordance with the Data Protection Act (1998). By filling in this form you are agreeing to: • Treat all the information you have access to both sensitively and securely • Be aware that breaches of data will be investigated and may be subject to disciplinary action and; • Be responsible for any loss or claims out of wilful improper use of any data.
Which system do you require access to?
Applicant's Details
Name

First name

Last name
Organisation / School Name
Address

Address Line 1

Address Line 2

City

County

Postcode

Country

Please fill out all fields to progress with form
Team
IP Address

This needs to be a static IP address which can only be supplied by your internet provider.
Phone
Email
Have you used Liquid Logic Systems before?
If Yes, please provide details (When/Where)

Please add in When and Where
Manager's Details
Name

First name

Last name
Email
Disclosure of Known People
Are you aware if a relative or friend has data in any Liquid Logic System?

A relative is defined as, a parent, parent-in-law, son, son-in-law, daughter, daughter-in-law, step-parent, step-son, step-daughter, brother, sister, or the spouse or ex-spouse of any of the preceding persons or, if that person is one of an unmarried couple, the other member of that couple.
If Yes, please provide details

E.g. J Smith - Partner, K Jones - Mother. Please include their home or business address
Do you share a household with anyone who has data in Liquid Logic?
If Yes, please provide Names
Form Submission
Please read and tick confirmation boxes before submitting your Access Request form.
Please confirm you have asked your manage to email their approval for your access.
YesNo
Please confirm that you have read and understood: The Data Protection Principles
YesNo
Please confirm that you have read and understood: Information Sharing Protocol Declaration
YesNo