Cincinnati State-Health and Public Safety Division Health Requirements Key and Checklist
Cincinnati State- Health and Public Safety Division Health Requirements Key and Checklist
Turn in this two- page checklist with your Physical Exam Report and any necessary supporting titer results. Write
in the date that each requirement was completed. Do not turn in paperwork until all items are complete.
Use this sheet as a cover sheet and staple behind it all supporting documentation.
1. Physical Exam Report
Students must submit a History and Physical Exam Report, completed by a health provider. The form must be dated within a year of submission and must include the health provider’s signature or stamp.
Completed ______
2. Immunizations
Immunization requirements are based on the Center for Disease Control (CDC) immunization recommendations for healthcare personnel. All immunizations must be kept up-to-date. Failure to do so may prevent students from attending class or clinical experiences.
Tdap (Tetanus diphtheria and pertussis)
• Evidence of Tdap immunization after 2005 is required
Completed______
Measles, Mumps, and Rubella
Students must submit proof of immunity to Measles (Rubeola), Mumps, and Rubella one of two ways:
• Proof of two (2) doses of the MMR (Measles, Mumps, Rubella) vaccine administered at least one month apart – one of which must have been given after December 31, 1979, or
• Proof of immunity for Measles (Rubeola), Mumps, and Rubella by submitting laboratory tests with positive titer levels in all 3 areas
Completed______
Hepatitis B Vaccine
Students must submit proof of immunity to Hepatitis B. Immunity is defined one of two ways:
• A series of three (3) vaccinations(dose #1 given, #2 one month later, #3 five months after #2)or
*Paperwork may be submitted after the first two doses are complete, but students are responsible for submitting documentation of dose 3 five months after dose 2.
• Titer result demonstrating immunity (must be 10 I.U. or greater)
Completed______
Varicella (Chicken Pox)
Students must submit proof of Varicella by either:
• Proof of documented physician-diagnosed illness (age or date of occurrence), or
• Proof of two (2) doses of the Varicella vaccine administered at least one month apart, or
• Proof of immunity to Varicella by submitting a laboratory test with a positive titer level
Completed______
Tuberculosis: TB Tests (PPD)
• One 2-step TB test must be done initially
• Step #1 is given and read within 48 to 72 hours; documentation of induration in mm must be provided
• Step #2 is given 7-21 days later and read within 48-72 hours;documentation of induration in mm must be provided
After the initial 2-step TB test is given, a follow-up TB is given yearly thereafter.Records for each yearly test must be provided. For individuals who miss their yearly test, the process will have to be repeated and another 2-step TB test will be given. If the TB test is positive, follow-up documentation of the positive result must be provided (i.e. chest x-rays).
• Alternatively, a QuantiFERON®-TB Gold test will also be accepted in lieu of a PPD skin test
Completed______
Influenza
• Evidence of an annual, seasonal flu vaccination may be required by facilities. Students will be notified of this by either AFWC or Fieldwork Site.
Completed______
3. CPR Certification
Evidence of CPR certification is satisfied by student submission of an American Heart Association or American Red Cross card verifying certification of completion of a Healthcare Provider or Professional Rescuer course in cardiopulmonary resuscitation. A copy of the front and back of the card is required. The card must be signed by the student. No on-line courses are accepted. Dates of the certification period must be evident. Students are responsible for keeping certification current throughout their time in a clinical experience.
4. First Aid Certification
Evidence of recent history of first aid certification is satisfied by student submission of an American Heart Association or American Red Cross card verifying completion of course. Online coursework is accepted.
Completed______
5. Health Insurance Coverage
Evidence of coverage under a policy of health insurance is satisfied one of two ways:
• Student submission of the front and back of a health insurance card or
•Student submission of a letter from an employer or insurance company which confirms active coverage under a policy of health insurance
Students are responsible for keeping coverage current throughout their time in a clinical experience.
Completed______
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