(Clause 18.3(a)(vi))

SCHEDULE c - Undertaking

For signing by each Student and delivery to Austin Health (AH) prior to commencement of placement or at first attendance

To: Austin Health

In consideration of Austin Healthagreeing to allow me to provide or participate in clinical training or research, as the case may be I:

1acknowledge that certain legislation relating to patient health care and records privacy (including the Health Services Act1988 (Victoria), the Information Privacy Act2000 (Victoria) and the Mental Health Act1986 (Victoria) impose on me duties of confidentiality and I agree to comply with those requirements as they apply to Austin Heath and its patients and that I am not permitted to, and will not, give to any other person, directly or indirectly, any information about any patient or AHobtained by reason of my participation or connection with my placement;

2agree that:

  • I am subject to, and will comply with, the by-laws, rules, policies and regulations of AH whilst onAH’s premises; and
  • I must comply with all directions of professional staff ofAHwhilst at AH;
  • I am responsible for payment of all medical and other health related costs arising out of any pre-existing injury or illness, or any new injury or illness contracted or arising out of a placement withAH, and for taking out adequate and appropriate health related insurance cover;
  • I must return any AHproperty toAH; and
  • I will not be an employee of AHbut may be required to wear identification in accordance with AHpolicy.

3warrant that:

  • I have undertaken training in manual handling techniques (where required);
  • I have met the requirements of AHfor immunisation, including:
  • immunity against Hepatitis B, Diphtheria, , Polio and Tetanus;
  • documented evidence of my Chicken Pox immunity;
  • documented evidence of my HIV, Tuberculin and Hepatitis C status;
  • demonstrated Measles/Mumps/Rubella immunity (applicable only if midwifery practice or experience is undertaken); and
  • I will not expose the staff and patients AHto the possibility of infection if I am infective and will advise AHimmediately.

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NameName of witness

……………………………………….……………………………………….

SignatureSignature of witness

……………………………………….……………………………………….

University of MelbourneDate

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