Fillable Health Assessment Record

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Health Assessment Record

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Country of origin: CANADA
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Health Assessment Record
Nursing Unit Clerk Certificate Program
Student Name:
Phone Number:
Address:
Family Doctor:
Physician Phone Number:
Health assessment indicating physical fitness and mental and emotional wellness.
The University of the Fraser Valley’s Nursing Unit Clerk program requires physical fitness and
emotional stability for students during course work, practicums, and future employment in
hospitals and or care facilities.
Examples of activities that students will be engaged in and commonly encounter during their
practicum and future employment include:
Frequent hand washing
Physical actions that require:
· Mobility
· Flexibility and strength
· Endurance
· Manual dexterity and the ability to function in limited spaces
· Ability to perform repetitive movements
· Bending, reaching, walking, and carrying objects
Emotionally stressful situations
Activities that require adequate sensory perception – sight, hearing and touch
Exposure to environmental smells and noise
Distractions
Unpredictable behaviour from those around you that may include aggression both verbal and
physical
Is this student capable of completing the physical activities above, and is mentally and
emotionally prepared to encounter emotional situations while attending practicum? Does this
student have the resilience needed to deal with job-related stress?
☐ Yes ☐ No
Note to explain:
X
Physician Signature
Date:
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Health Assessment Record

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Completed 25 June 2022

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