The students and faculty listed here are in compliance with the contractual health policies of the Clinical Education Setting including, but not limited to, certifying that each has received, prior to reporting to the Clinical Education Setting, a physical exam, are free from communicable disease, including tuberculosis (as documented by a negative skin test or negative chest x-ray, dated after skin test conversion, and are free from signs and symptoms of tuberculosis); have documented immunity to Rubella, Rubeolla, Mumps (MMR), and Varicella (positive titer) or shown evidence of immunization which meets ACIP definition of immunity (reported history of Chicken Pox is acceptable for Varicella immunity); have been advised of the risks of hepatitis and have either signed a waiver or have begun the Hepatitis B vaccination series or in the alternative, have completed the appropriate declination of immunization form, notice of which is provided to the Clinical Education Setting and have received the seasonal influenza vaccine within the last 12 months or completed and signed a declination form, notice of which is provided to the Clinical Education Setting.
The faculty and students listed have had a background check performed under the direction of the Institution in accordance with the Wisconsin Caregiver Background Check Law and have no adult criminal arrests with or without convictions.
The faculty and/or student(s) listed here DO have a criminal record on file. A copy of their completed Disclosure Form and criminal record report will be forwarded by fax or postal mail no less than two weeks prior to the start of the clinical experience. (If a student has been arrested for criminal code 940.19, 940.195, 940.20, 941.30, 942.08, 947.01 or 947.013 within the last 5 years, a copy of the criminal complaint and judgment of conviction must accompany the record.)
The nursing faculty and students listed are certified in American Heart Association or Red Cross, Health Care Provider, Basic Life Support.
