Step 3: Student Intake Form
Important! Part of this form involves proof of COVID-19 vaccination, a valid vulnerable sector check and respiratory mask fit. If you do not have the proper documentation at this time, please do not complete this form. Instead, wait until you are able to provide this information.
If you have any questions or need any assistance filling out this survey, please contact learning@hpha.ca.
Contact Information
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Emergency Contact:
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Program & Placement Info
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Immunization Requirements - Please refer to Pre-Placement Health Review
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COVID-19 vaccination is mandatory for all students. Please attach proof that you have received two doses of the vaccine.
In accordance with our COVID-19 Immunization policy, there are conditions that allow for a medical exemption (however, these are very limited). If this applies, please contact learning@hpha.ca for more information.
At any time during your placement at the Huron Perth Healthcare Alliance (HPHA), you may be required to show proof of immunization. In the event you have been contacted, please ensure you provide the required health review information to Occupational Health and Safety prior to your next scheduled shift. Please note: Failure to provide proof of and/or meet the mandatory immunization requirements may compromise your placement at HPHA. Ensure you are up to date and providing accurate information!
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Confidentiality Policy
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Acceptable Use of HPHA Computers/Electronic Resources Policy
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Medication - Narcotic and Controlled Medication Administration - Standard Work Policy
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Nursing and Respiratory Therapy Students will not have access to narcotic and controlled medications until their clinical instructor or preceptor attests to the student's ability to follow narcotic & controlled drug processes and policies & procedures by signing the "HPHA Narcotic and Controlled Substances Student Access Form"
E-Learnings
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Housekeeping Items
1. Depending on your placement program and structure, you may or may not be required to attend hospital orientation. This will vary
from 1 day to 5 days in length. If you are to attend orientation, this information will be communicated to you via email once this survey
response is received.
2. If you are working as a consolidating student under a preceptor, this information will also be communicated to you via email once this application is received.
3. A $20 fee is required for your student badge. This will be returned to you once your badge is returned at the end of your placement.
4. Parking is included in your badge but you will need to park in lots K or L which are across the street near the Avon Crest Building at Stratford General Hospital. There is no charge for parking at Seaforth Community Hospital, St. Marys Memorial Hospital, or Clinton
Public Hospital.
5. If you are completing any part of your placement between the months of October-April, you will be required to fill out a Seasonal
Influenza Immunization Declaration Form. Failure to do so may result in the termination of your student placement.
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Vulnerable Sector Check & Respiratory Fit Testing
Reminder! The next part of this form involves proof of a valid vulnerable sector check and respiratory mask fit. If you do not have the proper documentation at this time, please do not complete this form. Instead, wait until you are able to provide this information.
If you have any questions or need any assistance filling out this survey, please contact learning@hpha.ca.
A valid Vulnerable Sector Check is required by all students and should be uploaded now.
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Proof of fit testing is required by all students and should be uploaded now..