Student Orientation Checklist - Confidential once completed - Page 1 of 2
Version 2-2016
Department of Health
Student Orientation Checklist
Queensland Health requires you to review the Student orientation requirementsection on the
Clinical placements and work experiencewebsite prior to your placement. Please ensure that you have
read and understood the requirements before completing the checklist below.
Please tick the below boxes to indicate the areas you have read and understood. By ticking these boxes
you are agreeing to comply with the policies and requirements of each essential placement
requirement.
Blue card and criminal history
checks
Blue card
General criminal history check
Aged care criminal history check
Corrective services criminal history check
Code of Conduct
To whom does the code apply?
The four (4) ethics
principles
Cultural diversity
Organisational cultural competency framework
Aboriginal and Torres Strait Islander Cultural Framework 2010 -
2033
Vaccination
Measles, mumps, rubella (MMR)
Requirement: At least one dose prior to placement
Dose 1 date:
Dose 2 date:
Varicella (chicken pox)
Requirement: At least one dose prior to placement
Dose 1 date:
Dose 2 date:
Pertussis (dTpa) (whooping cough)
Requirement: One adult dose within the last ten years
prior to placement
Dose date:
Hepatitis B
Requirement: At least two doses prior to placement
Dose 1 date:
Dose 2 date:
Dose 3 date:
Other recommended vaccinations
Name:
Dose date:
Occupational health and safety
Mandatory iLearn online modules – prior to placement
Work Health and Safety Induction
First-Response Evacuation Instructions
Occupational Violence Prevention Fundamentals
Prevention and Management of Musculoskeletal Disorders (MSD)
Mandatory OHS requirements – At placement
Local site induction
Privacy, confidentiality and
documentation
Privacy
Confidentiality
Documentation
Student Orientation Checklist - Confidential once completed - Page 1 of 2
Version 2-2016
Department of Health
I, (Please enter your full name) certify that I have read
and understood the preceding topics on the Queensland Health Clinical placements and work experience
website in preparation of my placement.
Signature:
Date:
Infected health care worker - student responsibilities
I declare and agree that I have read and understand the Guideline ‘Management of
Human Immunodeficiency Virus (HIV), Hepatitis B Virus, and Hepatitis C Virus Infected Healthcare
Workersand acknowledge that this standard also applies to students on placement in Queensland Hospital
and Health Service facilities.
I declare that I understand my disclosure responsibilities under the Responsibilities of the HBV/HCV/HIV
infected healthcare workers
1
.
I acknowledge and understand that health care workers (including students and supervisors) who are
hepatitis C antibody and PCR positive, hepatitis HBV DNA positive, or HIV antibody positive must not
perform exposure prone procedures as defined in the Guideline.
I agree to comply with the guidelines and all procedures in place at the Queensland Hospital and Health
Service facility at which I am placed, in respect of Queensland Health vaccination and infection control of
health care workers.
I understand that this orientation is one of the requirements of eligibility for a placement at a Queensland
Hospital and Health Service facility.
Name:
Course:
Signature:
Date:
1
Disclosing a HIV/HBV/HCV positive status will not preclude a student from being considered for a placement. However, the student will
not be permitted to participate in any exposure prone procedure while on placement. The student should consult their education
provider to determine whether completing their placement/program notwithstanding those restrictions will still enable them to achieve
required learning outcome and qualification in their course of study. Queensland Health will keep confidential the students declarations
save
if
required
by
law
to
disclose.
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