Instructor/Student Affiliations

ORIENTATION CHECKLIST / / Student Name
Instructor Name & School
Start Date & Site

A.Self-Study: Instructors and students should have reviewed the mandatory online orientation materials and confirmed completion on the Wheaton Franciscan Healthcare website. This checklist is used to document department orientation.

B. Department Orientation  = REVIEWEDNA = NOT APPLICABLE

Orientation Items Covered in the Department
Department Overview
Scope and Hours of Service
Expectations for the Journey-Living the Values at the Department Level
Key People/Contacts in Department
Current Performance Improvement Activities
Dress Code and Uniforms
Service Recovery Kit (if applicable)
Unit resource person/contact
Facility Tour
Building & Department Tour
Restrooms & Lockers
Parking
Needle and other Disposal Containers
Work Station
Supplies and Equipment
Communications
Computer (Access, Training, and Policies)
Telephone, Cell Phone and Paging System
Communication Boards
Shift to shift report/ handoff communication
Work Schedule
Procedures for Being Away From Workstation
Breaks and Lunch
Call-in Procedure for clinical groups and precepted students / Safety
Safety & Infection Control P&P Manuals
Material Safety Data Sheets Manual (if applicable)
Emergency Procedures Reference Chart
General Policy & Procedures Manuals
PPE (Personal Protective Equipment)
Department Specific Roles for Codes
Code Cart
Utilities Failure Procedures (nearest Power Failure Phone)
Panic Buttons & Security Alarms
Fire Extinguishers, Alarm Box/Station & Exits
Flashlights & Batteries
Oxygen shut off
Lifting/ transferring patient (ergonomics and equipment)
Medication Safety
Medication Administration
Medication Reconciliation
MAR overview
Computer/ADU (Diebold) Access (if applicable) / Competencies
Restraints-if applicable (Return demonstrations of application and quick release knot)
Point of Care Testing :
Blood Glucose Monitoring (if applicable)
Other (List): ______
______
______
Department equipment (as applicable for student level / scope)
IV pump
PCA pump
Enteral Feeding pump
Other: (List)
______
______
Documentation System
**Applicable Electronic Health Record applications
Instructors Only
Electronic student clinical placement process
Communicating student assignments to units
Communicating student skills to assigned staff members
Process for reserving meeting rooms

This instructor/student has completed department orientation.

______

Instructor/Student Signature Date Instructor/Orientor Signature

Directions: After completing the orientation, please return this form (via fax, interoffice, U.S. mail, or email) to:

1. For WFH-All Saints: 2.For Iowa sites:

System Operations Department- Lower Level, Health PavilionWheaton Franciscan Healthcare-Iowa,

3821 Spring St.Clinical Development

Racine, WI 534053421 W. 9th Street

Fax: 262-687-4557 Attn: Nicole HartmannWaterloo, Iowa 50702

Fax: 319-272-5125 Attn: Iva Ruehs

3. For all Marianjoy (Illinois) sites:4. For WFH - Milwaukee Rehabilitation Clinics:

Marianjoy Rehabilitation Hospital and ClinicsWheaton Franciscan Rehabilitation Services

Attention of: (Discipline specific educator. Ex: Nursing, Physical Therapy, etc.)851 S 70th Street

26W171 Roosevelt RoadWest Allis, WI 53214
Wheaton IL 60187Fax: 414-465-4728Attn: Nicole Ponda
Phone: 630-909-8000

Fax: 630-909-6960 Attn: Angela Killian

5. For all other WI WFH sites:

Wheaton Franciscan Healthcare

Office of Integrated Care

4300 W. Brown Deer Road, Suite 114

Brown Deer, WI 53233

Fax: 414-465-3064 Attn: Alison Van Dyk

Updated 07-2015