Start EARLY as some requirements may take several weeks to complete. Review the requirements carefully and review the form again before submitting to ensure all sections are completed correctly. Contact your clinical placement risk management nurse advisor if you have any questions.
Locate previous records BEFORE having the form completed (records may be obtained from your family physician, Occupational Health Services if you worked or volunteered in a hospital, or Public Health Services where you attended high school in Canada).
If previous records are missing or incomplete, you will need to complete a new series for required vaccinations; all documented doses count towards the total series as long as minimum spacing requirements are met (there is no maximum).
Complete the Student Information section in full. An email address is required for communication with your nurse advisor. Please add your nurse advisor’s email to your safe senders list to ensure that you receive our emails.
All requirements must be documented in full and initialed by a qualified health care professional (physician, nurse, physician assistant, pharmacist). Health care professional (HCP) information, signature and date are required for each HCP who documents one or more requirements on the form.
Tetanus-Diphtheria-Polio vaccines and Hepatitis B vaccines/test for immunity (anti-HBs) may be in process at program start but as much as possible, must be completed prior to program starts for provisional clearance. All other requirements must be fully completed for clearance. Exemptions are allowed for medical reasons only, in which case a note from a physician is required.
Attach copies of required reports. Vaccination records should also be attached if available. Make sure your name is on every page submitted.
Do not alter the original form after submission. A separate update form will be provided for outstanding requirements.
Keep a copy of all documents on file in case they are required at a future date. Documents submitted to the Faculty of Health Sciences Risk Management Nurse Advisors are NOT returned.