Student Training Pharmacy & Nursing

Student Training EMS
Name (Legal name)*

First NameLast 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: WHStudent26*
https://rise.articulate.com/share/4Kn3_Dw-Qjvg_1tfZczOWKGOPFK9RjaP
Download the Certificate for required regulatory training here: *

Cancelof

TB Risk Assessment & Symptom Evaluation- please type your full name*
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. *
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.*
Close contact with someone who has had infectious TB disease since the last TB test.*
Productive, persistent cough lasting 2-3 weeks in duration?*
Blood in sputum?*
Night Sweats?*
Weight loss not caused by dieting?*
Fatigues, tires easily?*
Unexplained fever or shortness of breath?*
If "Yes" to any question please explain:
My signature below indicates that my TB Risk Assessment is accurate: *
Date*

MonthDayYear
Date

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: *

Cancelof
Should be Empty:

Student Training EMS