HEALTH, WELLNESS AND SCIENCES
Clinical Preparedness Permit
REQUIRED DOCUMENTATION FOR CLINICAL PLACEMENTS AND COURSE PARTICIPATION ELIGIBILITY.
Important:
Read all permit documents carefully. These are time sensitive.
Please ensure your Health Care Practitioner signs this permit and initials all boxes where required.
ALWAYS keep your originals!
Lab results must accompany this permit, where required.
Remember to make a photocopy of your permit after each update and store it in a safe and secure place.
This is your personal information and as such is confidential.
Please Note: There are costs associated with permit checking, immunizations, lab tests and certifications. Please keep all receipts for income tax purposes.
Please see page3for Program due dates and exceptions. Please refer to your Program Coordinator, or Synergy, regarding any questions you may have.
Synergy Information
Website:
Synergy HelpDeskat705-300-0036(Mon - Fri,10amto3pm)
Students are requiredto:
1.Keep this permit up-to-date and current at alltimes.
2.Have an authorized health care provider sign-off and providethe appropriate lab report(s) to support the immunizationrecord.
3.Present this permit and original documents for reviewannually.
4.Present the stamped permit on the first day of the clinicalplacement.
5.Make sure the permit is available to present if requested at theclinical placementsite.
Please note: Students will not be eligible for Clinical Placement or any course requiring proof of documentation, unless their permit is completed and stamped.
MISSEDCLINICAL TIME MAY JEOPARDIZE SUCCESS IN THECOURSE.
Ontariolegislationspecifiescertainsurveillancerequirementsforthoseentering intoapracticesetting. TheHealth, Wellness and SciencesStandards weredevelopedin accordancewiththePublicHospitalsActandarebasedontheCanadian ImmunizationGuide7thEditionandCanadianTBStandards.
Clinical Permit Due Date and Exceptions:
EXCEPTIONS to the main permitPROGRAM / Permit
Due / Mask Fit Test / Vulnerable Sector Screen (VSS)
Acupuncture / 2nd Semester / No exception / No exception
Communicative Disorders Assistant / 1st Semester / No exception / No exception
Denturism / 3rd Semester / Not required / No exception
Dental Assisting / 1st Semester / Not required / Required for Semester 3
Dental Hygiene / 1st Semester / Not required / Required for Semester 5
Esthetician / 2nd Semester / Not required / No exception
Medical Skin Care Therapy / 1st Semester / Not required / No exception
Massage Therapy / 3rd Semester / No exception / Required at start of both Semester 3 5
Occupational Therapist Assistant and Physiotherapist Assistant / 2nd Semester / No exception / Every 6 months / CPR recertification every 2 years
Paramedic / 2nd Semester / Yearly / Every 6 months
Paramedic—Advanced Care / 2nd Semester / Yearly / Every 6 months
Personal Support Worker / 1st Semester / No exception / Every 6 months
Pharmacy Technician / 2nd Semester / 4th Semester / 2nd semester—Police Check 4th Semester—VSS
Practical Nursing / 1st Semester / No exception / Every 6 months
ClinicalPreparednessPermit
RevisedJune27, 2017
TuberculosisScreeningMandatory Lab Reports (To be completed by Health CareProvider)
TUBERCULOSIS
Is an infectious disease spread through air by coughing, sneezing or spitting. Classic symptomsareachroniccoughwithblood-tingedsputum,fever,nightsweatsandweightloss.
Pleaseindicate, to your Health Care Provider,anyliving,travelorworkhistoryinwhichyoumayhavebeenatriskfor tuberculosis
1.Documentation of a Base-line Two Step Mantoux skin test is required for allnew students.
a)Students who have never completed TB testing must complete a Base-line Two Step Mantoux skin test.
b)Students who have a previously documented negative Two Step test must complete a One Step test.
c)Students who have received a BCG vaccination are not exempt from Mantoux testing.
2.Students who have had a previously documented positive Mantoux testshouldnot receive further Mantouxtesting.
ClinicalPreparednessPermit
RevisedJune27, 2017
a)If a student has a previously documented positive Mantoux Two-Stepscreening and has received investigation – a copy of chest x-ray report from this yearanda note must be provided indicating that the “student is free from signsand symptoms of active tuberculosis” and must be included in thispackage.
b)A chest x-ray every 2 years is required for positive Mantouxtest.
3.For any student that tests positive for the firsttime:
a)Include results of the positive Mantoux screening (mm ofduration).
b)A chest x-ray is required and the report must be enclosed in thispackage.
c)The responsibility for follow-up lies with the physician as perOHA/OMA Communicable Disease Surveillance Protocols.
Chest x-ray – Date &Result: Chest x-ray – Date &Result:
Health Care ProviderInitials:
ClinicalPreparednessPermit
RevisedJune27, 2017
ClinicalPreparednessPermit
RevisedJune27, 2017
MMR (Measles, Mumps,Rubella)
Serology/Titres are required. Lab results must be included with thisPermit .
**Note: If you do not demonstrate immunity on your serology, even though you have been vaccinated, please include the dates of vaccination, as these may be sufficient for your placement agency.Your case will be reviewed by the Placement Office.
1st Dose MMR:
2nd Dose MMR:
Born in Canada prior to 1970 (DOB):
LabReports
Immune
Rubella:Yes No Indeterminate
Mumps:Yes No Indeterminate
Measles:Yes No Indeterminate
Health Care ProviderInitials:
ClinicalPreparednessPermit
RevisedJune27, 2017
Varicella (ChickenPox)
Serology/Titres are required. Lab results must be included with thisPermit
**Note: If you do not demonstrate immunity on your serology, even though you have been vaccinated, please include the dates of vaccination, as these may be sufficient for your placement agency. Your case will be reviewed by the Placement Office.
1st Dose Varicella:
2nd Dose Varicella:
Has had varicella (chicken pox): YesNo
Polio
If immunization required, 3 doses are recommended: the first 2, 4 to 8 weeks apartand the third dose should be 6 to 12 months later. The first one immediately, the secondone, one month after the first and the third one 6 to 12 monthslater.
ClinicalPreparednessPermit
RevisedJune27, 2017
Hepatitis B
Serology/Titres are required 4-6 weeks after 3rd vaccination.Lab results must be included with thisPermit.
Students may enter clinical placements as long as they have had at least their 2nd Hep. Bvaccine because it is a 6-12 month wait for the 3rd vaccine.
If the 3rd vaccine was missed please contact Synergy directly for next steps.
For non-responders, additional doses, up to another complete series of three, canbe done, with testing for response after each dose. Persons who fail to respond tothree additional doses of vaccine are unlikely to benefit from furtherimmunization.These students will have the option to sign a waiver regarding personal health risks – refer to Synergy.
Tetanus/Diphtheria (TD)/Pertussis
A Tetanus/Diphtheria booster within the last 10 years isrequired.
One dose of Adacel is recommended if booster has not been administered within last10 years.
If previously not immunized 3 doses are recommended. The first one immediately,the second one, one month after the first and the third one 6 to 12 monthslater.
NB: If immunization is required have Tetanus/Diptheria andPertussis.
ClinicalPreparednessPermit
RevisedJune27, 2017
.
INFLUENZAVACCINEIS ONLY AVAILABLE DURING FLU SEASON (OCTOBER/NOVEMBER)In the event ofan outbreak at your placement, any student without the vaccination will bedeniedaccess to the facility thereby jeopardizing successful completion of theclinical course.
Please bring proof of your Influenza Vaccine to your placement agency. / InfluenzaVaccine
YearDateReceivedHealthCareProviderSignature
1stYear
2ndYear
3rd Year
Influenza Vaccination (FluShot)
INFECTION CONTROL
MaskFitTestingtobescheduledatthecollege.Information regardingavailable dates willbegiveninthe firstweeksofthesemester.
Respirator Mask Fit Testing (Completed Every TwoYears)Please indicate your N95 size, type and date oftesting.N95Type / Size / Dateof Issue
Respirator Mask Fit Testing is bookedthrough Synergy. You will beadvised when the dates are available for booking and will sign up online for testing using the link on Page 1. If you miss your appointment, itis your responsibility to obtain a Mask Fit at your ownexpense.
Students are required to be fit tested for an N95 respirator prior to their 1stclinical placement and at least every two yearsthereafter.
Please note that if you lose/gain a significant amount of facial weight orexperience changes in your facial shape, i.e. trauma, surgery or pregnancy, fit-testing should berepeated earlier.
ClinicalPreparednessPermit
RevisedJune27, 2017
CRIMINAL RECORDS
Vulnerable Sector Police Record Checks
Prior to having direct contact with patients and other vulnerable persons,community agencies and hospitals require a satisfactory Vulnerable Sector Police RecordCheck. This police check must be renewed every twelve months (unless otherwise stated on Page 3).
Our Hospital, Long Term Care and Paramedic Service partners require that students’ VSS be current within 6 months. Please check Page 3 to see if this is a requirement of your program.
Please note: depending onthe service used this process may take up to 12 weeks or more, so be sure to applyearly. Students are required to carry their VSS/Police Check to the clinical area.A representative in the agency may ask to see that you have a valid Vulnerable Sector Screen/Police Check at anytime.
Failure to obtain a vulnerable sector (or extended) police clearance will prevent students from starting their clinical course and may impede or prevent successful completion of the course.
Many regulatory colleges require a Vulnerable Sector Screen/Criminal Record Check prior to registration. In the event that the applicant hasa criminal record they will not be permitted to write the provincial exam and thus notbecomea certified professional. If the applicant has a criminal record or obtainsa criminal record during undergraduate education a pardonmust beobtained to be eligible for provincial exams.
Vulnerable Sector Police Record Checks are available through your local police serviceonly. Toronto Police and South Simcoe Policehave specific forms and requirements, please see a Placement Officer to obtain these. OPP require a particular letter and form, please see yourProgram Coordinator for additionalinformation.
CERTIFICATIONS
Standard First Aid and CPR for Health Care Providers(Level HCP)
(EveryYear)
Standard First Aid and CPR (Level HCP) are requiredupon entry into the program. CPR (Level HCP) requires a minimum re-certificateevery year regardless of the expiry date on the card.
It is the student’s responsibility to ensure that the certificate is current throughout theprogram.
WHMISThe WHMIS module is available through this link:
Students require a minimum grade of 80% to pass. Please print your certificate following completion of the module remembering to select Georgian College so it appears on the certificate. / Date of Issue
Studentsarerequiredtocompletetheabove section,andkeepsupportingdocumentationwith thispackageatalltimes.
Ministry of Labour - Worker Health and Safety Awareness Certification
Thiscertification isavailable on theMinistryofLabourwebsite, via afree eLearning module.StudentsmustaccesstheeLearning modulefromany computer, completethetraining and print thecertificate ofcompletion.
It is crucialyou printyourowncertificate at thetimeof completionbecausetheMinistrydoes not maintain adatabase. You needto completethemodule in asinglesitting,it isnotpossible tostoppart waythroughandresume atalatertime/date.The website indicates that the moduletakes45-60minutestocomplete. / Date of Issue
Studentsarerequiredtocompletetheabove section,andkeepsupportingdocumentationwith thispackageatalltimes.
ToaccesstheeLearning module
1. Use acomputerwith audio and aprinter.
2. Visitthiswebsite:
3. Click thelink titled“Access theeLearning Module”.
4. Completethe eLearningmodule.
5. Print yourcertificate ofcompletion.
6. Keep yourprintedcertificateofcompletionwith your permit.
Proceed to: / Proceedto: / Proceedto: / Proceedto:
Approvedby: / Approvedby: / Approvedby: / Approvedby:
ClinicalPreparednessPermit
RevisedJune27, 2017
ClinicalPreparednessPermit
RevisedJune27, 2017