Student Training EMS
Name
*
First Name
Last Name
Email
*
example@example.com
Scan the QR code or click the link below to complete required training:
(Must be completed by ALL Students & Instructors)
Use this password to login for required regulatory training: #WHTrain24/25
*
https://rise.articulate.com/share/5rCMESfenuIumZVb0JGs3OshqmjZZ0rL
Download the Certificate for required regulatory training here:
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Parking Form
Clinical Student Parking Information- put NA if you are not driving yourself
*
Print the parking form for your reference:
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TB Risk Assessment & Symptom Evaluation- please type your full name
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Temporary or permanent residence of greater than or equal to 1 month in a country with high TB rate. Any country other that the United States, Australia, New Zealand, Northern or Western Europe.
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Current or planned immunosuppression. Including human immunodeficiency virus (HIV) infection, organ transplant recipient, treatment with a TNF-alpha antagonist (e.g. infliximab, etanercept, or other), chronic steroids (equivalent of prednisone greater or equal to 15mg/day for greater or equal to 1 month) or other immunosuppressive medication.
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Close contact with someone who has had infectious TB disease since the last TB test.
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Productive, persistent cough lasting 2-3 weeks in duration?
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Blood in sputum?
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Night Sweats?
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Weight loss not caused by dieting?
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Fatigues, tires easily?
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Unexplained fever or shortness of breath?
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If "Yes" to any question please explain:
My signature below indicates that my TB Risk Assessment is accurate:
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Date
*
-
Month
-
Day
Year
Date
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Fit Testing
Review the acceptable and unacceptable types of facial hair- This form may be printed for your reference.
Print and complete this form. Download in the box below after completed
Upload completed Respiratory Questionnaire here:
*
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