How to obtain vaccination records Obtaining vaccination records Follow instructions on Blackboard to navigate through to Sonia where all pre-placement information and placement associated information is located. Evidence of baby book/school records is essential if vaccination card has not been completed in full by a qualified clinician AND you are relying on this as evidence. How to correctly submit your vaccination evidence Follow the below instructions as stated before advised due date. FIRST Students need to upload the Professional Experience Obligations and Disclosure Consent form (available for download on Sonia) as per Sonia upload instructions. The PEU are unable to forward your documents to NSW Health without this consent. SECOND Students must email their vaccination evidence to healthosv@scu.edu.au (instructions below). 1. Open a new email from your SCU Student Email account. Provide the following detail in the subject line: Student Name Discipline SCU Placement Start Date. In the body of the email complete the following information: Name: Student ID: Mobile: Email Address: Discipline of Study: Campus: 4. Attach the following to the email Attachment Document Notes 1 Completed SCU Vaccination Record Card 4 5 Evidence of baby book/school/gp records if applicable Evidence of any/all serology reports Attachment 6 Undertaking/Declaration Form Attachment 7 Tuberculosis (TB) Assessment Tool Essential if vaccination card has not been completed in full by a qualified clinician AND you are relying on this as evidence ALL serology results must be obtained and attached for further evidence. Results written on the record card alone will not be accepted Must ensure all relevant check boxes have been ticked and bottom of form has been signed and dated Must ensure all relevant check boxes have been ticked and bottom of form has been signed and dated Requirements for attaching documents to this email: DO NOT take photos of your documents as these files tend to be too large for one email and we may be unable to forward your documentation to the NSW Health vaccination assessor on your behalf Documents must be correctly oriented, legible and attached in the order provided in the above table. Regards, PEU Team healthosv@scu.edu.au 07 5589 4 Lismore Z Block Gold Coast Level, Building B Room.15 Coffs Harbour M1.1 1
Personal details (Student to complete) Surname Student vaccination record card Required for ALL SHHS students undertaking Professional Experience Given names Address Date of birth Town State Postcode Student ID Campus Contact number Gold Coast Lismore Coffs Harbour Health Professional to complete Vaccine Date Batch No. Official Certification by Vaccination Provider (Clinic/Practice stamp, full name and signature - in each vaccine section) Adult formulation diphtheria, tetanus, acellular pertussis (whooping cough) vaccine (adult dose of dtpa vaccine not ADT vaccine) Booster * Hepatitis B vaccine (age appropriate course of vaccinations AND hepatitis B surface antibody 10mIU/mL core antibody positive) Dose ** Dose AND Serology: anti-hbs Result mlu/ml Result mlu/ml Serology: anti-hbc Pos. Neg. Measles, Mumps and Rubella (MMR) vaccination or positive serology Dose Serology Measles Serology Mumps Serology Rubella Varicella vaccine (age appropriate course of vaccination positive serology documented history of physician diagnosed chicken pox or shingles) *** Dose Serology Varicella must attach serology report * required 10 years after previous dose ** minimum requirement for first placement *** if given before age 14 dose is not required
Vaccination Requirements Evidence Checklist Required for ALL SHHS students undertaking Professional Experience Acceptable evidence of protection against specified infectious diseases includes: Written record of vaccination signed by the medical practitioner, and/or serological report of protection and/or other evidence, as specified in the table below. NB: Health district may require further evidence of protection, e.g. serology, if the vaccination record does not contain vaccine brand and batch or official certification from vaccination provider (e.g. clinic/practice stamp) Copies of vaccination records (e.g. childhood vaccinations) and copies of all serology reports must be attached to the card. Please complete and include NSW Health Forms & (please ensure all relevant check boxes are ticked & dated) Disease Evidence of Vaccination Serology Results/Report Other acceptable evidence Diphtheria, tetanus, acellular pertussis (whooping cough) One adult dose of pertussis containing vaccine (dtpa) within the last 10 years Do not use ADT vaccine as it does not contain the pertussis component Serology will not be accepted Hepatitis B Completed age appropriate course of hepatitis B vaccine 1 NOT Accelerated course AND Anti-HBs greater than or equal to 10mlU/ml Documented evidence of anti-hbc, indicating past hepatitis B infection Measles, mumps, rubella (MMR) Varicella (Chickenpox) doses of MMR vaccine at least one month apart doses of varicella vaccine at least one month apart (Evidence of one dose is sufficient if the person was vaccinated before 14 years of age) Positive IgG for measles, mumps and rubella 4 Birth date before 1966 Positive IgG for varicella Tuberculosis (TB) * See below for list of persons requiring TST screening Tuberculin Skin test (TST) Performed by a Tuberculosis Service, private pathology not accepted. Any student who believes they may require TST testing should contact the PEU to facilitate the appointment. Influenza Annual influenza vaccination is strongly recommended but not mandatory * TST Screening is required if the person was born in a country with high incidence of TB, or has resided for a cumulative time of more than months or longer in a country with a high incidence of TB, as listed at: http://www.health.nsw.gov.au/infectious/ tuberculosis/documents/countries-incidence.pdf However please submit Forms & prior to obtaining screening. 1. Hepatitis B vaccine is usually given as a dose course with 1 month minimum interval between 1st and nd dose, months minimum interval between nd and rd dose and 4 months minimum interval between 1st and rd dose. For adolescents between the ages of 11 15 hepatitis B vaccine may be given as a two dose course, with the two doses 4 6 months apart.. A person receiving an accelerated course of hepatitis B vaccinations will not have completed the course until they have the 4th dose 1 months after the first dose.. Anti-HBs (hepatitis B surface antibody) greater than or equal 10 IU/ml indicates immunity. If the result is less than 10 IU/ml (<10 IU/ ml), this indicates lack of immunity. 4. Students must receive positive results for MMR or they will be required to obtain x MMR injections 4 weeks apart PRI to first placement. If any result is not positive then student must contact the PEU immediately.
Occupational Assessment, Screening and Vaccination Against Specified Infectious Diseases PROCEDURES Attachment 6 Undertaking/Declaration Form All new recruits/other clinical personnel/ students /volunteers / facilitators must complete each part of this document and Attachment 7 Tuberculosis (TB) Assessment Tool and provide a NSW Health Vaccination Record Card for Health Care Workers and Students and serological evidence of protection as specified in Attachment 4 Checklist: Evidence required from Category A Applicants and return these forms to the health facility as soon as possible after acceptance of position/enrolment or before attending their first clinical placement. (Parent/guardian to sign if student is under 18 years of age). New recruits/other clinical personnel/ students /volunteers / facilitators will only be permitted to commence employment/attend clinical placements if they have submitted this form, have evidence of protection as specified in Attachment 4 Checklist: Evidence required from Category A Applicants and submitted Attachment 7 Tuberculosis (TB) Assessment Tool. Failure to complete outstanding hepatitis B or TB requirements within the appropriate timeframe(s) will result in suspension from further clinical placements/duties and may jeopardise their course of study/duties. The education provider/recruitment agency must ensure that all persons whom they refer to a NSW Health agency for employment/clinical placement have completed these forms, and forward the original or a copy of these forms to the NSW Health agency for assessment. The NSW Health agency must assess these forms along with evidence of protection against the infectious diseases specified in this policy directive. Part Undertaking/Declaration 1 I have read and understand the requirements of the NSW Health Occupational Assessment, Screening and Vaccination against Specified Infectious Diseases Policy a. I consent to assessment and I undertake to participate in the assessment, screening and vaccination process and I am not aware of any personal circumstances that would prevent me from completing these requirements, b. I consent to assessment and I undertake to participate in the assessment, screening and vaccination process; however I am aware of medical contraindications that may prevent me from fully completing these requirements and am able to provide documentation of these medical contraindications. I request consideration of my circumstances. I have provided evidence of protection for hepatitis B as follows: a. history of an age-appropriate vaccination course, and serology result Anti-HBs 10mIU/mL b. history of an age-appropriate vaccination course and additional hepatitis B vaccine doses, however my serology result Anti-HBs is <10mIU/mL (non-responder to hepatitis B vaccination) c. documented evidence of anti-hbc (indicating past hepatitis B infection) or HBsAg+ c a b a b 4 d. I have received at least the first dose of hepatitis B vaccine (documentation provided) and undertake to complete the hepatitis B vaccine course (as recommended in the Australian Immunisation Handbook, current edition) and provide a post-vaccination serology result within six months of my initial verification process. I have been informed of, and understand, the risks of infection, the consequences of infection and management in the event of exposure (refer Attachment 5 Specified Infectious Diseases: Risks and Consequences of Exposure) and agree to comply with the protective measures required by the health service and as defined by PD007_06 Infection and Control Policy. d Declaration: I declare that the information provided is correct Full name: Worker cost centre (if available): D.O.B: Worker/Student ID (if available): Email: NSW Health agency /Education provider: Signature: Date: PD018_009 Issue date: March-018 Page 40 of 4
Occupational Assessment, Screening and Vaccination Against Specified Infectious Diseases PROCEDURES Attachment 7 Tuberculosis (TB) Assessment Tool All new recruits, other clinical personnel, volunteers and students are required to complete this Tuberculosis Assessment Tool along with a NSW Health Record of Vaccination for Health Care Workers and Students and Attachment 6 Undertaking/ Declaration Form. They should advise the NSW Health agency if they prefer to provide this information in private consultation with a clinician. The NSW Health agency will assess this form and decide whether TB screening or clinical review is required. New recruits, other clinical personnel and volunteers will only be permitted to commence duties if they have submitted this form to the employing NSW Health agency. Failure to complete outstanding TB requirements within the appropriate timeframe may affect their employment status. The education provider must forward a copy of this form to the health service for assessment. Existing Category A staff, clinical personnel, volunteers and students who spend more than months in a country with high incidence of TB after their initial TB assessment must complete and submit this tool for reassessment on return to a NSW Health agency. Part A 1. Do you currently have a cough that has lasted longer than weeks? Yes No. If yes, have you had any episode of haemoptysis (coughing up blood)? Yes No. Have you had unexplained fever, chills or night sweats in the past month? Yes No 4. Have you had any unexplained weight loss in the past month? Yes No If you answered yes to any of the above questions, please attach relevant details on a separate page, including all results of any investigations or medical assessment you may have had it to this form. Part B 1. What is your country of birth?. Have you ever in your lifetime (new personnel), or since your last occupational TB Assessment (existing personnel), lived or travelled overseas? If yes, provide details Yes No Country Duration of stay Approximate dates/ year (attach a separate page if necessary). Have you ever had contact with a person known to have TB? Yes No If yes, detail the nature of the contact (attach separate page if necessary): 4. Have you ever been tested for TB before? Yes No If you answered yes to any of the above questions, please attach further information on a separate page, including the date and results of any previous tests for TB (including TST, IGRA, sputum culture, chest x-ray) and attach it to this form Worker/Student Declaration: I declare that the information provided on this form is correct Full name: Date of birth: / / Phone: Email: Signature: Worker cost centre (if applicable): Student ID (if applicable): NSW Health agency /Education provider: Date: PD018_009 Issue date: March-018 Page 41 of 4