1 HUMBER COLLEGE & UNIVERSITY OF GUELPH-HUMBER FIELD PRE-PLACEMENT REQUIREMENTS FIRST YEAR ECE / ECAS STUDENTS EARLY CHILDHOOD EDUCATION ADVANCED STUDIES IN SPECIAL NEEDS PLEASE READ CAREFULLY: ANY QUESTIONS REGARDING THE DETAILS BELOW PLEASE CONTACT SIMONE VOLPE, PLACEMENT PREREQUISITES OFFICER FOR CLINICAL / FIELD PLACEMENTS; AT simone.volpe@humber.ca OR 416-675-6622 X.4026 NOTE: YOU MUST COMPLETE THESE STEPS IN THIS ORDER! *PLEASE ENSURE THAT WHEN YOU BEGIN THIS PROCESS YOU KEEP IN MIND THE DATES REQUIRED AND THE LENGTH OF TIME FOR PROCESSING; SOME REGIONS REQUIRE A FEW MONTHS TO PROCESS YOUR REQUEST* 1. Following registration, full tuition fee or deposit payment and receiving your Student ID number; go to the Field Clinical Placement main page at your academic School of Health Sciences web page. 2. Make an appointment with your Health Care Provider; if you do not have one please visit the Health Centre at Humber College 2nd Floor LRC or any Walk-In Clinic available. It is your responsibility to ensure that the Field Pre-Placement Requirement Form is properly completed and signed by your Health Care Provider, BEFORE you book your appointment for field placement clearance. If for medical reasons you are unable to receive the required immunization, your Health Care Provider must include a detailed written explanation for this exclusion. Subsequently, for any reason you do not receive a mandatory vaccine, you MUST sign an Immunization Waiver Form at Humber College. The cost of completing the requirements is paid by the student entering the program. 3. Your program requires a *VULNERABLE SECTOR POLICE RECORD CHECK* that MUST be current within 6 months of the start of your field placement AND valid to the end of your placement. The cost associated with this service and any appeals are paid by the student. It is recommended you check with your local police department to determine how long it will take to process your Vulnerable Sector Police Record Check. Please ensure that when you begin the process you keep in mind the dates required and the length of time for processing. *Some regions require a few months to process your request.* 4. Ensure your *STANDARD FIRST AID CERTIFICATE* is valid for 3 years and your *CPR LEVEL C CERTIFICATE* is renewed annually. Courses to meet this requirement are available at Humber College at http://healthsciences.humber.ca/resources/pre-placement-requirements/standard-first-aid-cpr.html. 5. Make an appointment with Simone Volpe at simone.volpe@humber.ca; Placement Prerequisites Officer - Clinical / Field Placements; located in the School of Health Sciences North in Room K201H to clear your immunization requirements and other non-medical clearance. If your forms and documents are not complete you will be asked to return for another appointment. 6. Bring ALL original forms/documentation/certificates with you to the appointment with Simone Volpe. Once the documentation has been reviewed, you will be provided with a field placement clearance card or more information on what is required. *FIELD PRE-REQUISITES CLEARANCE FEE IS $40.00 WHICH WILL BE INVOICED TO YOUR STUDENT ACCOUNT*
2 HUMBER COLLEGE & UNIVERSITY OF GUELPH-HUMBER FIELD PRE-PLACEMENT REQUIREMENTS FIRST YEAR ECE / ECAS STUDENTS PROGRAM YEAR: CAMPUS: FIRST LAST STUDENT ID #: EMAIL ADDRESS: HOME PHONE #: CELL PHONE #: MANDATORY MEDICAL REQUIREMENTS HEALTH CARE PROVIDER (HCP) MUST COMPLETE ENTIRE FORM IN FULL TUBERCULOSIS (TB): A two-step Tuberculin Skin Test is required only once if properly performed and documented. A TB skin test is required within the last 6 months. Students with a negative TB skin test MUST have a Single-Step TB Skin Test every 6 months. If the student has a documented history of a previous positive TB skin test (induration measuring equal to or greater than 10mm) or Active TB, a TB skin test is NOT REQUIRED. Proceed to Chest X-Ray. TB SKIN TEST STEP 1 VACCINE NAME TUBERSOL/MANTOUX DATE GIVEN SITE/ROUTE/DOSE (I.E. R FOREARM 0.1 CC INTRADERMAL) DATE READ 48-72 HOURS FROM TEST RESULT: INDURATIONS IN (MM) HCP INITIAL STEP 2 (7-21 DAYS AFTER STEP 1) TUBERSOL/MANTOUX *IF EITHER TB SKIN TEST STEP IS POSITIVE (10 MM INDURATION), PLEASE EVALUATE AS FOLLOWS* CHEST X-RAY: MUST be done within the last 6 months (ATTACH X-RAY RESULTS AND DOCUMENTATION): CHEST X-RAY DATE CHEST X-RAY RESULTS INH TREATMENT PRESCRIBED YES OR NO ASSESSMENT: Students with a positive TB Skin Test MUST have their HCP assess their chest every 6 months and document that they are free from TB signs and symptoms and that the student does not have active TB: DATE OF ASSESSMENT RESULTS (NEGATIVE= NO SYMPTOMS OF TB) (POSITIVE= SYMPTOMS OF TB)
3 IMMUNIZATION: IMMUNIZATION RECORD/YELLOW CARD REQUIRED MEASLES / MUMPS / RUBELLA (MMR): Students should have documented evidence of receiving 2 doses of the MMR vaccine on or after their first birthday. If the student cannot provide documentation of MMR vaccines, laboratory blood test results (resulting in a positive titre) proving immunity to measles, mumps, and rubella is required. If blood work results show the student is not immune or indeterminate to measles, mumps and/or rubella, 2 MMR vaccines, given at least 4 weeks apart are required. If the student has documentation of 1 MMR, 1 booster MMR is required. ATTACH DOCUMENTATION OF VACCINATIONS AND IMMUNITY. MMR #1 VACCINE NAME DATE GIVEN SITE/ROUTE/DOSE MMR #2 MMR BOOSTER (ONLY IF REQUIRED) BLOOD TITRE BLOOD TITRE DATE BLOOD TITRE RESULTS (IMMUNITY) MEASLES MUMPS RUBELLA VARICELLA (CHICKENPOX): Laboratory blood test results (resulting in a positive titre) proving immunity is required regardless of history of illness. If blood work results show the student is not immune to chickenpox, 2 doses of the Varicella vaccination, given at least 4 weeks apart are required. ATTACH DOCUMENTATION OF VACCINATIONS AND IMMUNITY. VACCINE NAME DATE GIVEN SITE/ROUTE/DOSE VARICELLA DOSE # 1 VARICELLA DOSE # 2 BLOOD TITRE BLOOD TITRE DATE BLOOD TITRE RESULTS (IMMUNITY) VARICELLA
4 HEPATITIS B (HB): Laboratory blood test results proving immunity is required. If the student is not immune, you may require a booster dose or 3 Hepatitis B vaccines if you have never been vaccinated. At least 2 doses of the vaccine are required for clinical placement. (Proof of 2 doses of Hepatitis B if received in grade 7 is required. Proof of 3 doses of Hepatitis B vaccine is required if received as an adult). Laboratory blood test for HBsAb & HBsAg is required. ATTACH DOCUMENTATION OF VACCINATIONS AND IMMUNITY. VACCINE NAME: PLEASE CIRCLE (RECOMBIVAX HB, ENGERIX B OR TWINRIX) DATE GIVEN SITE/ROUTE/DOSE If the student is not immune after 3 injections, they will need a booster of Hepatitis B; and after 4-6 weeks, a blood test titre to check immunity. If the student is still not immune, the student will have to complete the 2nd series (2 more injections). A blood test titre is required 4-6 weeks after second full series. VACCINE NAME: (RECOMBIVAX HB, ENGERIX B OR TWINRIX) DATE GIVEN SITE/ROUTE/DOSE BLOOD TITRE BLOOD TITRE DATE BLOOD TITRE RESULTS (IMMUNITY) HEPATITIS B HBSAB HBSAG *IF THE STUDENT IS NOT IMMUNE TO HEPATITIS B AFTER THE SECOND FULL SERIES, PLEASE BOOK A FOLLOW-UP APPOINTMENT WITH YOUR HCP*
5 TETANUS / DIPHTHERIA / PERTUSSIS (TDAP): If the student has not received Pertussis as an adolescent or adult, they require the Adacel Vaccination. Even if you have a current dose of T/D done in the last 10 years you will need one dose of Adacel done in adulthood. A T/D booster is required every 10 years. IMMUNIZATION VACCINE NAME DATE GIVEN SITE/ROUTE/DOSE (I.E. R FOREARM 0.1 CC INTRADERMAL) PERTUSSIS (ONCE AS AN ADULT OR ADOLESCENT) TETANUS/DIPHTHERIA (EVERY 10 YEARS) ADACEL T/D HEALTH CARE PROVIDER INFORMATION (HCP): THE STUDENT HAS MET ALL THE PROGRAM REQUIREMENTS NEEDED TO ATTEND CLINICAL PLACEMENT: YES NO DATE: HCP NAME (PLEASE PRINT): : HCP SIGNATURE: PROFESSION (PLEASE CIRCLE): RPN RN NP MD TELEPHONE #: ADDRESS: CLINICAL STAMP:
6 MANDATORY NON-MEDICAL REQUIREMENTS PLEASE CONSULT WITH YOUR PROGRAM COORDINATOR FOR NON-MEDICAL REQUIREMENTS *NOTE: PLEASE RETAIN ALL ORIGINAL COPIES OF YOUR DOCUMENTS TO HAVE AVAILABLE FOR FIELD PLACEMENT AGENCIES AS THEY MAY ASK TO SEE THEM WHEN YOU BEGIN YOUR PLACEMENT* NON-MEDICAL REQUIREMENT STANDARD FIRST AID CERTIFICATE (EVERY 3 YEARS) DATE ISSUED EXPIRY DATE DOCUMENT PROVIDED YES OR NO CPR C CERTIFICATE (ANNUAL) VULNERABLE SECTOR POLICE RECORD CHECK (EVERY 6 MONTHS)